Shortage of health workers

IMPLEMENTATION OF CONTENTIOUS LEGISLATION REMAINS ‘A PIPE DREAM’ FOR NOW Bill was rejected by Cabinet last week.

The shortage of healthcare professionals across the country means the implementation of the National Health Insurance (NHI) scheme will likely remain nothing but a pipe dream, according to the 21st edition of the SA Health Review published by the Health Systems Trust.

Coinciding with the United Nations universal health coverage (UHC) yesterday, the report noted the “critical importance of [human resources for health], without which the UHC will remain a pipe dream”.

The review comes amid speculation that the NHI Bill was rejected by Cabinet last week, followed by reports that the contentious piece of legislation will be discussed in a special Cabinet meeting in January.

One of the most contested aspects of South Africa’s push to UHC through the NHI is the critical shortage of health workers in the public sector, especially in rural areas, and the inequity in terms of the distribution of health personnel when compared to the private sector.

The authors repeatedly noted the gap in data in quantifying the gaps in the health work force but noted that there were 106 518 public sector vacancies in 2010 for 14 clinical health professions.

The shortage is even more pronounced in rural areas: despite the fact that almost half of the population lives in these areas, only 12% of doctors and 19% of nurses work there.

The report noted that R12 billion is spent every year on health sciences education but that this “economic investment” with “recurring benefits” often falls short in retaining health workers in underserved and rural areas.

About 1 200 medical students graduate in the country yearly, yet only about 35 end up working in rural areas long term.

While community service – the period when health workers are placed in public health facilities on completion of their studies – has brought skills to these communities, strategies are needed to retain them long term.

Research has shown that doctors originating from rural areas are significantly more likely to return to work in those areas and the SA Health Review highlighted a KwaZulu-Natal project providing financial and educational support for rural pupils to become health workers.

“Extension of the model may increase the number of healthcare workers in rural areas, which is promising given that staffing rural areas is likely to be a major challenge in the successful rollout of the National Health Insurance system,” noted the authors. – ANA