Development of Human Resources Regarding Health in South Africa

Introduction 

Human Resources for Health (HRH) is defended as a collaboration between all individuals who their primary intent to improve health. In addition, HRH is believed to be one of the core components of a health system, which if neglected will impact the act of all the health system sectors. Moreover, HRH consists of those who deliver direct and indirect services such as doctors, trained nurses and midwives, community health workers and health supply. Furthermore, the availability, production and distribution of health workers play a major role in achieving any health system goals such as Universal Health Coverage (UHC). While there is an ongoing increase in the world population and medical invitations beside the strengthen of diseases, the need for sufficient and effective health workers has become a controversial issue. (World Health Organisation, 2009). However, HRH system is varied among countries due to some factors such as economic, management and educational which result in delayed services and poor health outcomes(Rawat, 2012). Therefore, this essay will be examined some HRH challenges and discussed introduced reforms. This will be done by focusing on the HRH regarding nurses in South African and concluded by giving some recommendation that may help to enhance its HRH. 

Challenges Associated with Human Resources for Health in South Africa   

Human Resources for Health is believed to be one of the most complex building blocks for any health system(World Health Organisation, 2009). Over the last decades, the shortage of professional health workforce, particularly in the nursing workforce, the poor distribution of health workers among the regions and between the public and private sectors, in addition to the undesirable work environment is believed to be some of the challenges for HRH in South Africa(Department of Health, 2011). The former may be due to the shutdown of nursing colleges in the 1990s and non-governmental organisations(Day, Gray, & Budgell, 2016). This may be attributed to the slight increase of professional nurses which was about 40786 in 2002, to touched around 47863 in 2007(Department of Health, 2011). The seek for a better work environment and job opportunities have increased the migration number of Health Professionals, particularly nurses. In 2006, the total number of health worker migration reached around 23407, while the nurse's workforce accounted for 6844 of the total(Department of Health, 2011). The second might be due to the unequal spread of health workers between the public and privet sectors which is located more in the urban area. This because of the highest payment in the private sector compared to the public and the lack of work prospects in the public sectors compared to the privet. Also, the dangerous environment in the rural areas besides the poor social infrastructure and daily life need has influenced more stuff to avoid these places.   Although 44% of the total population lives in the rural dwellers, around 19% of physicians and 12% of nurses of the total number of health workers operated there(Department of Health, 2011). Moreover, about 35% of the total annual alumnae employed for long terms in the rural areas. Finally, the huge workload, the high-risk factor of getting infected, low morale and poor management in the workplace has led to increasing the number of staff turnover rates by 80%, which has led to decreases in the productivity and the quality of care(Department of Health, 2011). As a result, the inequity of access, high burden of diseases in South Africa, particularly in the rural areas, poor serves delivery has been noticed(Department of Health, 2008). Thus, the need to addressee these challenges faced by the staff is crucial to avoid further challenges.

The Reforms of Human Resources for Health in South Africa

The South African government has been trying to implement different strategies to address HRH challenges(GAIN, 2015). The nursing profession is an essential part of HRH. If neglected, it may potentially affect the health outcomes as well as universal coverage(Department of Health, 2008). Therefore, in 2008, the Department of Health of South Africa introduced six nursing strategies that aim at reducing the challenges that faced by nurse’s workforce in South Africa. Their goals are to ensure a sufficient number of professional nurses to cover the shortages. Also, guaranteed equal destitution of the stuff among the region in order to achieve equal access and implemented appropriate policies to create a healthy work environment to improve the quality of care served(Department of Health, 2008). One of the strategies was to enhance the education and training systems. This will be done by increasing the number of nursing colleges and improver the subject that given to future nurses and retrained the current nurses to cope with the current innovations and care perspective. Also, follow up for this strategy was taken into consideration to ensure the outcomes efficacy. This will be applied by a collaboration between the Department of Health of South Africa(DoH) and, South African Nursing Council (SANC) and Nursing Educational Institutions (NEI)(Department of Health, 2008). Furthermore, enhance the resources for nursing and support the social location were recommend. The former objectives are to provide the nurses with the equipment they need to protect themselves against pathogens. In addition, sufficient fund that may help to develop their skills. Increase the salary has been also considered. Therefore, an engagement between DoH, DoE, Private Sector and SANC is a need for this strategy to be effective(Department of Health, 2008). The latter will be done by offering appropriate accommodation for nurses during their training and government support to own one during employment, particularly in the rural areas, in order to reduce the distribution between rural and urban centres Also, promote the nursing career to engorge people to join the field, by offering attractive job options and safe future was added. This will be done by an arrangement between the DoH, NEIs, Provincial Departments of Health and the Private Sector(Department of Health, 2008).  While these strategies were suggested to improve the HRH in South Africa, evaluating whether they have reduced these challenges or not will be critically discussed in the next part.

Evaluation for the Reforms of Human Resources for Health in South Africa 

Although the nursing strategy in 2008, highlighted different approaches to address the challenges, it did not have a strong impact on the HRH. However, the vision has influenced other reforms such as The Strategic Plan for Nursing Education, Training and Practice in 2013 and HRH Strategy for the Health Sector: 2012/13–2016/17(Matlakala, 2016). As a result, regarding the education system, four new nursing qualifications announced and implemented in 2015. Nonetheless, due to poor management and governance failures from both the SANC the National Department of Health (NDoH) to implementation these qualifications, the use of them was delayed till 2018. Thus, the impact of them on the health work performance may not happen soon(Day et al., 2016). Secondly, the unequal spread of workforces between urban and rural areas and between the public and private health sectors still a problematic. By looking at the number of training professional nurse’s outcomes in 2014, around 1 234 professional nurses were graduate from two institutions in the urban areas compared to only 501 professional nurses from three rural institutions. This may be due to the postponement of the implementation of educational transformations(Day et al., 2016). While there is still lack of legalisation of control the movement between the privet and public sector, the move of nurse’s cause maldistribution. Finally, the staff shortage still a problem need to solve. This may due to the poor outcomes from the medical university. In 2015, the total number of nurses and midwives was 391 517(GAIN, 2015). With regard to the total number of population which was about 56 million in 2016, with only 59 – 66 years life expectancy in 2015(World Health Organization, 2018), the number is considered low when it is compared to the huge burden of diseases and the population. 

Recommendation

South Africa is suffering from an unequal distribution of workforces between urban and rural areas. While the poor infrastructure and the weak salary in the public hospitals might be the reasons behind this dilemma, the use of sustainable financial incentives to encourage the workforce to retain at these places may help to reduce this challenge and provide equal care access. In addition, enhance the infrastructure of the rural areas is believed not only to attract more staff, but also to improve the health outcomes for these populations. For example, building medical cities outside the capitals, modernise facilities, and high-ranking institutions(World Health Organization, 2010).   

Conclusion

Human Resources for Health is believed to be one of the hardest concept to achieve in the health system. While it plays a major role to accomplish UHC, the need for continuous evaluation and reforms to provide the sufficient number of highly skilled workforce, well distribution of staff and high performance is important. However, the South Africa government seems to be struggling to guarantee an appropriate HRH system. Despite the implemented reforms, there is an insufficient number of trained health worker, lack of effective policies and unequal spread of the caregivers. This may be due to the poor governess system, delay to take an action and weak education system. Consequently, the population suffer from enormous burden of diseases which has reflected on their life expectancy which is quite low when is compared to other countries. Therefore, the government should provide extra support for those who decide to work in the rural areas to improve access to health and create better social and physical environment might be helpful too. While this may help to reduce the obstacles, delaying them may lead to HRH crises and increase the poor outcomes.