1. Presented by: Charlyn Goliath Stellenbosch University

2. 2008 WHO report – Mid level health workers: The state of the evidence on programmes, activities, costs and impact on health outcomes 2008 DOH Provincial and National: Community needs to define roles; HPCSA multi-skill vs profession specific; Generalist vs specialist; Role of supervision; Training support Community Care Worker Management Policy Framework: Draft version 6 CBS – Service delivery framework NSDA – National Service Delivery Agreement Reengineering of PHC

3. Health care provider who have received less training and have a more restricted scope of practice than professionals Have formal certificate accreditation through country licensing bodies Terminology – auxiliary, assistant, technician

4. Skills mix SAQA Role of the HPCSA Stakeholder engagement

5. Challenges: Skill mix imbalances Urban-rural distribution Poor working conditions Accreditation standards

6. Task shifting: delegating tasks to existing or new cadres with either less training or narrowly tailored training “All health professionals in all countries should be educated to mobilise knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient and population- centred health systems as members of locally responsive and globally connected teams”

7. Individual level: Independence in ADL, Increase social integration, Mobility Advice and counselling - PWD self-awareness Good relationships – PWD achieve own goals Group level: Peer support Families and parents of PWD: Counselling and training Family relationships

8. Community: Change in community attitude Disability awareness campaigns

9. 48% of clients – Cat 3 – rehabilitation 59% – HBC; 25% -prevention and promotion; 16% - adherence and support Part of proposed PHC teams Deliver programs on all levels Supervision: CSP: Role of therapists – “Education, training, support to....” Human Resource plan for Therapists Training and qualification – stakeholder engagement on all levels Career pathing

10. Skills mix: “Is our current skill mix responding to our country’s need?” “What skill mix is needed to respond and to improve the country’s health indicators?” SAQA: “What are the constraints to introduce flexibility into education and training policies to adjust the skill mix to evolving needs and technology?” HPCSA: “What informal task shifting is occurring outside scope of practice regulations?”

11. Labour market for health professionals Health System: Needs Demands Provision Demand for health workforce Population Education System Needs Demands Provision Supply of health workforce