CHAPTER 1 – INTRODUCTION AND OVERVIEW OF THE STUDY



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|NO |ITEMS |PAGE NO |

|1 |External and Internal Stakeholders and their |4-5 |

| |responsibilities | |

|2 |Introduction |5 |

|2.1 |Background |6-9 |

|2.2 |Vision |10 |

|2.3 |Mission |10 |

|2.4 |Legal Mandates and Other Policy Mandates |10-11 |

|2.6 |Departmental Programmes |12-16 |

|3. |Departmental Strategic Goals |16-19 |

|4. |Strategic Objectives of the |19 |

| |Recruitment and Retention Strategy | |

|5. |Environmental Scan (External & Internal Scan) |20-27 |

| |Factors that contribute to Staff Turnover |28-29 |

| |Examples of what some Health Professionals say on Exit Interviews. |30 |

|6. |Best Practises as Recommended by World Health Organisation (WHO) |31 |

| |Relevance of the WHO recommendations to the Departmental Recruitment and Retention Strategy | |

|7. |Intervention Strategies |33-36 |

|8.1.1 |Recruitment Plan |38 |

|8.1.2 |Bursary Projections and Costs |39-40 |

|8.2 |Infrastructures Development |41-44 |

|9. |Monitoring and evaluation |45 |

|10. |Implementation Plan |46-51 |

|11. |Financial Implications |52 |

|12. |Impact of Strategy on Service Delivery |53 |

SENIOR GENERAL MANAGER: CORPORATE SERVICES (SIGN OFF)

This Recruitment and Retention Strategy for Health Professionals, has been Reviewed by Ms. MJ Mojapelo in my capacity as Senior General Manager: Corporate Services.

I am satisfied and concur with the content of this Recruitment and retention Strategy for Health Professionals and will ensure that the Department achieves the strategic objectives as outlined in the strategy.

|SIGNED | |

|DESIGNATION | |

|DATE | |

HEAD OF DEPARTMENT (SIGN OFF)

This Recruitment and Retention Strategy has been Approved by Ms. Daisy Mafubelu in my capacity as the HOD for Limpopo Department of Health.

I am satisfied and concur with the content of this Recruitment and Retention Strategy for Health Professionals.

|SIGNED | |

|DESIGNATION | |

|DATE | |

1. STAKEHOLDERS AND THEIR RESPONSIBILITIES

In line with the Guidelines introduced by the Department of Public Service and Administration (DPSA), the Department has identified key stakeholders in the development, implementation, monitoring and evaluation of the Recruitment and Retention Strategy of Health Professionals. Below are the key stakeholders and their responsibilities:

Internal Stakeholders:

|STAKEHOLDERS |RESPONSIBILITIES |

| |Is accountable for the overall management of Recruitment and Retention |

|Head of Department |Strategy. |

| |Providing strategic direction and monitoring the implementation of the |

|Executive Management |Recruitment and Retention Strategy. |

| |Ensuring compliance with Recruitment and Retention Strategic within their |

|Senior Management Service |respective Divisions. |

| |Ensuring compliance with Recruitment and Retention Strategy within the |

|Districts and Institutions Management Services |District Offices and Institutions. |

| |Are individually and collectively responsible for the implementation, |

|Managers |management, monitoring and evaluation of the Recruitment and Retention |

| |Strategy in their respective Business Units. |

| |Employee representatives in the form of organised labour. They play a role |

|Labour |in the process of consultation, monitoring and evaluation of the |

| |Recruitment and Retention Strategy. |

External Stakeholders:

|STAKEHOLDERS |RESPONSIBILITIES |

|Department of Public Service and Administration |Provide technical advice and support on the development and |

| |implementation of Public Policies. |

|Office of the Premier |Coordinating body for the Province. |

|National Department of Health |Provide technical advice and support on the development and |

| |implementation of Health Policies. |

|Institutions of Higher Learning |Sources of supply for Health Professionals. |

|Foreign Countries such as Cuba |Training and Development of Health Professionals. |

2. INTRODUCTION

Limpopo Department of Health is situated in Limpopo Province which is 80% rural and 20% semi-urban with less recreational facilities. The Department is struggling to recruit and retain Health Professionals such as Medical Officers, Nursing Personnel, Pharmacists and Allied Health in order to meet the health care needs of this Province.

The high turnover of the above mentioned Health Professionals remains a challenge in the Department. This situation informed the development of Recruitment and Retention Strategy aimed at ensuring that the Department is able to attract, recruit, and retain Health Professionals.

1. BACKGROUND

|Population Profile |

|FIGURE 1 |

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|The Province of Limpopo is situated in the north of the Republic of South Africa. It shares borders with the provinces of Gauteng,|

|Mpumalanga and North West. It also shares borders with the Republic of Mozambique in the east, Zimbabwe in the north and Botswana |

|in the west. The estimated population is 5.23 million (Stats SA,2009). The population of Limpopo is youthful, with 35.7% (2,5 |

|million) being children under the age of 15 years. Close to six out of ten people (59.6%) are economically active, while elderly |

|people are in the minority, making up 4.7% of the provinces’s population. Females consitute the majority, making up 52.3% (2,73 |

|million) of the province’s population. The age and gender scenario decribed in this paragraph, is shown in the Figure 1 above. |

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| |

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|Estimated population for Limpopo by district and GENDER, 2009 |

|District |

|Male |

|Female |

|Total population estimate |

|Percentage share of the provincial population |

| |

|Capricorn |

|595 369 |

|645 199 |

|1 240 569 |

|23.73 |

| |

|Vhembe |

|582 122 |

|655 203 |

|1 237 324 |

|23.67 |

| |

|Waterberg |

|299 798 |

|295 193 |

|594 991 |

|11.38 |

| |

|Mopani |

|510 695 |

|555 629 |

|1 066 324 |

|20.40 |

| |

|Sekhukhune |

|507 116 |

|580 876 |

|1 087 992 |

|20.81 |

| |

|Total |

|2 495 100 |

|2 732 100 |

|5 227 200 |

|100.0 |

| |

| |

|From a district perspective, Limpopo consists of five districts as indicated in the Table above. The province’s population is |

|unevenly distributed among the districts, with 47.4% of the population concentrated in Vhembe and Capricorn Districts. However, |

|there is slight change in the population distribution, and Vhembe District is no longer the most populated District in the province|

|as indicated in the Table above. Proportionally, more people are currently found in Capricorn District than in Vhembe District. The|

|2009 population estimates highlight migration as a key demographic process in the explanation of the current population |

|distribution in Limpopo. When it comes to gender structure, districts generally emulate the provincial picture – females |

|outnumbering males - with the exception of Waterberg District where males slightly outnumber the females (50.4%). |

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|FIGURE 2 :Burden of diseases |

| |

|As shown in Figure 2 above, there were a few outbreaks of communicable diseases and severe emerging infectious diseases, |

|particularly severe acute watery diarrhoea’s (cholera) and more recently H1N1 influenza. Limpopo reported a total of 4 634 cholera |

|cases, with 30 laboratory confirmed deaths (case fatality rate of 0.65%) from 15th November 2008 to 01 June 2009. The majority of |

|the cases were females which accounted for 51% (2 667) whilst children less than five years of age accounted for 14.2% (652). |

| |

|Human rabies is the most fatal disease in Limpopo as it has a case fatality of 100%. Most dog bites and confirmed human rabies |

|cases are reported in Vhembe District. The incidence of confirmed human rabies in Limpopo has decreased from 22 in 2006, to two in |

|2007, two in 2008, and one in 2009. A total of 7122 animal bites were reported from health facilities in Limpopo for the financial |

|year 2008/2009. The large proportion of cases were reported from Vhembe (75%), followed by Mopani (15.9%), and Capricorn (5.6%). |

|The least number of cases were reported from Sekhukhune (2.1%) and Waterberg (1.4%) districts. |

|Although malaria cases have shown a gradual decline over the past 10 years, the malaria case fatality rate remains above the |

|National Target of 0.5 %. Seasonal malaria increases are also experienced during the malaria season, with upsurges experienced |

|during the 2010/2011 financial year. |

|FIGURE 3 |

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|FIGURE 3: Limpopo HIV prevalence among antenatal women by district, 2006-2010. |

| |

|The prevalence of HIV varies among districts in Limpopo, and this is not a unique feature for this particular province. Figure 3 |

|above shows the prevalence of HIV by district in Limpopo during the period 2006-2010. The information in Figure 3 shows that the |

|prevalence varies not only between districts but also within districts over time. Generally HIV prevalence is higher in Waterberg |

|and Mopani districts than in the remaining three districts, with Vhembe district registering the lowest prevalence since 1990 |

|(National Department of Health, 2010). |

| |

2. VISION

An optimal and sustainable health care service in Limpopo

3. MISSION

The provision and promotion of a comprehensive, accessible and affordable quality health care service to improve the life expectancy of the people

2.4 LEGAL MANDATES

• The Constitution of South Africa, Act 108 of 1996

• National Health Act, 61 of 2003

• The Public Finance Management Act, 1 of 1999

• Basic Conditions of Employment Act, 75 of 1997

• Public Service Act,103 of 1997 as amended

• Employment Equity Act,55 of 1998

• Skills Development Act of 1998

• Public Service Regulations 2001 as amended

• Promotion of Access and information Act, 2 of 2000

• Labour Relation Act, 66 of 1995

• Occupational Health Safety Act, 85 of 1993

5. OTHER POLICY FRAMEWORKS

• Outcomes 2 and 12 of the Medium Term Strategic Framework for 2009 to 2014.

• Limpopo Provincial Employment, Growth and Development Plan.

• Limpopo Provincial Growth and Development Strategy.

• The National Human Resource for Health (HRH) Plan (2006):

o Emphases that the key to resolving the chronic HRH shortage in South Africa lies in the increased production of skilled health sector human resources.

• The National Scarce Skills List (2006) of the Department of Labour:

o Defines Registered Nurses (RNs) and Primary Health Care Nurses (PHCNs) as scarce skills.

6. ALIGNMENT WITH NATIONAL DEPARTMENT OF HEALTH 2010/11-2014/15 STRATEGIC PLAN.

|Priority 1: |Provide strategic leadership and creation of a social compact for better health outcomes. |

|Priority 2: |Implement a National Health Insurance plan. |

|Priority 3: |Improve quality of Health Services. |

|Priority 4: |Overhaul the Health Care System and improve its management. |

|Priority 5: |Improve Human Resources Planning, Development, and Management. |

|Priority 6: |Revitalise the physical infrastructure. |

|Priority 7: |Accelerate the implementation of the HIV and AIDS Strategic Plan and increasing the focus on TB |

| |and other communicable disease. |

|Priority 8: |Mass-mobilise better health for the population. |

|Priority 9: |Review the Drug Policy. |

|Priority 10: |Strengthen Research and Development. |

2.6.1 KEY ACTIVITIES FOR PRIORITY 5 ABOVE INCLUDE THE FOLLOWING:

• Refinement of the HR Plan for Health.

• Re-opening of nursing schools and colleges.

• Recruitment and Retention of Health Professionals, including urgent collaboration with countries that have excess of these professionals.

• Training of PHC personnel and mid-level health workers.

• Assessment and review of the role of the Health Professional Training and Development Grant (HPTDG) and the National Tertiary Services Grant (NTSG), and

• Managing the coherent integration and standardisation of all categories of Community Health Workers.

7. DEPARTMENTAL PROGRAMMES

1. PROGRAMME 1: ADMINISTRATION

Purpose: to provide strategic management and overall administration of the department including rendering of advisory, secretarial and office support services through the sub programmes of Administration and Office of the MEC.

Priorities:

• Improving financial management and control.

• Implementation of supply chain management system.

• Implementation of risk management strategy.

• Implementation of effective and efficient monitoring and evaluation systems.

• Implementation of knowledge, records, information management systems and technologies.

2. PROGRAMME 2: DISTRICT HEALTH SERVICES

Purpose: To render Primary Health Care Services and District Hospital Services through the following sub-programmes:

• Primary Health Care Services.

• Districts Hospitals.

• HIV and AIDS, Sexually Transmitted Infections (STI) and Tuberculosis (TB) Control Programmes.

• Mother and Child and Women’s Health (MCWH) and nutrition.

• Disease Prevention and Control.

Priorities:

• Improve quality of care.

• Combating HIV and AIDS and decreasing the burden of diseases from Tuberculosis.

• Increase life expectancy.

• Increase access to health care services.

• Reduce Maternal and Child morbidity and mortality.

• Strengthening health system effectiveness.

2.7.3 PROGRAMME 3: EMERGENCY MEDICAL & PATIENT TRANSPORT SERVICES

The aim of this programme is to render pre-hospital Emergency Medical Services, including Inter-Hospital transfers and Planned Patient Transport through the sub-programmes of Emergency transport and planned patient transport.

Priorities:

• Improve quality of Health Care.

• Strengthen implementation of Planned Patient Transport transfer within EMS.

• Provision of Custom built stations.

• Recruit, train and retain skilled personnel.

• Digitalisetion of EMS ICT systems.

2.7.4 PROGRAMME 4: PROVINCIAL HOSPITALS (REGIONAL AND SPECIALISED)

The purpose is delivery of hospital services, which are accessible, appropriate, and effective and provide general specialist services, including a specialised rehabilitation service, as well as a platform for training health professionals and research through the sub-programmes general (regional) hospitals and specialised hospitals.

Priorities:

• Expansion of secondary hospital services.

• Implement quality improvement programmes in all provincial hospitals.

• Implement a sustainable outreach programme.

• Develop and implement the provincial nursing strategy.

2.7.5 PROGRAMME 5: CENTRAL & TERTIARY HOSPITALS

The purpose of this programme is to provide tertiary health services and create a platform for training of health professionals and research.

Priorities:

• Improve quality of Health Care.

• Increase access to tertiary services.

• Reduce referrals outside the Province.

• Implement sustainable outreach programme.

2.7.6 PROGRAMME 6: HEALTH SCIENCES AND TRAINING

The purpose of the programme is to render training and development opportunities for actual and potential employees of the Department through sub programmes human resource development.

Priorities:

• Provide health professional training and other categories.

• Continuing professional development programme.

2.7.7 PROGRAMME 7: HEALTH CARE SUPPORT SERVICES

The purpose of the programme is to render support services as required by the Department, to realise its aim and to incorporate all aspects on rehabilitation through sub-programmes:

• Medical trading account (Pharmaceutical Services).

• Orthotic and Prosthetic (Allied Health Care Support Service).

• Oral health services, and

• Forensic Pathology Services.

Priorities:

• Availability of medicine and medical sundries at the depot, hospitals and PHC facilities.

• Increase facilities with full complement of Health Care support services.

• Strengthen Forensic Pathology Services.

2.7.8 PROGRAMME 8: HEALTH FACILITIES MANAGEMNT

The purpose of the programme is to plan, provide and equip new facilities/assets, and upgrade, rehabilitate and maintain hospitals, clinics and other facilities.

Priorities:

• Upgrade of PHC facilities.

• Upgrade of hospitals.

• Provide new academic Hospitals.

• New Malaria facilities.

• New EMS facilities.

• Upgrade of Forensic Pathology Services facilities.

• Provide staff accommodation.

• Upgrade nursing college and nursing schools.

• Provide suitable Pharmaceutical Depot.

• Provide water, sanitation and electrical services (new and upgrade).

3. DEPARTMENTAL STRATEGIC GOALS

The Department’s strategic goals are identified as follows:

|Strategic goal |Goal statement |Rationale |Expected outcomes |

|Effective corporate governance provided |Ensure an effective corporate |Support the implementation of |Improve quality of health |

| |governance system by 2014. |the Departmental plans and |services by 2014. |

| | |programs to improve service | |

| | |delivery. | |

| | | | |

|Strategic goal |Goal statement |Rationale |Expected outcomes |

|Appropriate human resources management and |Ensure appropriate HRM and |A need to optimise the |Improve realisation of the |

|development provided. |development services by 2014. |realisation of the strategic |Department’s objectives. |

| | |objectives of the Department | |

| | |through human resource | |

| | |management and development | |

| | |services. | |

|Sound financial management practice |Ensure efficient and effective |A need to ensure fiscal |Improved accountability on |

|promoted. |financial and supply chain |discipline and optimisation of |financial resources resulting |

| |management by 2014. |resource allocation. |in well-funded and managed |

| | | |health services. |

|Implementation of comprehensive care and |Develop and implement plans for the|A need to reduce morbidity and |Reduce morbidity and mortality.|

|management of HIV and AIDS, TB, STIs and |provincial priority programs by |mortality related to the burden| |

|other communicable diseases accelerated. |2014. |of diseases. | |

|Decreasing Maternal and Child mortality. |Ensure implementation of programmes|A need to reduce morbidity and |Reduced morbidity and |

| |targeting women and children. |mortality in pregnant women and|mortality. |

| | |children. | |

|Strategic goal |Goal statement |Rationale |Expected outcomes |

|Strengthen District health and hospital |Implement 80% of DHS components in |A need to ensure equitable |Improved access to health |

|services. |all districts and sustainable |access to health care services.|services. |

| |outreach programme at all levels of| | |

| |care by 2014. | | |

|Improve quality of health care. |Implement quality improvement plans|Improve client satisfaction and|Reduced morbidity and mortality|

| |in the districts and hospitals by |clinical outcomes. |in the province. |

| |2014. | |Improved client satisfaction |

| | | |and patient safety. |

|Improve Emergency Medical Services. |Ensure that 90% of EMS calls are |A need to respond to calls |Reduce morbidity and mortality |

| |responded to within nation norm of |within the norm in order to |in the province. |

| |15 minutes in rural areas and 40 |save lives. | |

| |minutes in urban areas by 2014. | | |

|Tertiary services development. |Tertiary/academic services |Improved and increased access |Increased access to tertiary |

| |increased from 22 to 37 in line |to tertiary services in the |services. |

| |with the Modernisation of Tertiary |province. | |

| |Services Document. |Developed teaching platform in | |

| | |the province. | |

| | |Reduced referrals to other | |

| | |provinces. | |

|Strategic goal |Goal statement |Rationale |Expected outcomes |

|10 Improve infrastructure development and |Implement a reviewed 5 year |Health services delivery needs |Improved access and quality of |

|maintenance |infrastructure development and |for additional infrastructure |health services. |

| |maintenance plan by 2014. |expansion. | |

4. STRATEGIC OBJECTIVES OF THE RECRUITMENT AND RETENTION STRATEGY:

• To identify best ways/methods that can be used and applied to attract, recruit and retain health professionals within the Department.

• To improve and strengthen the existing methods used to address problems pertaining to recruitment and retention within the Department.

• To develop and promote flexible ways of working within the Department.

• To design a flexible retirement plan that will encourage staff reaching retirement age to remain at work longer, or alternatively to return to work post-retirement.

• To provide high quality learning and development for all Health Professionals.

• To identify strategies and mechanisms that can be used and applied to the improvement of the infrastructure.

5. ENVIRONMENTAL SCAN (EXTERN & INTERNAL SCAN)

5.1 APPLICABLE EXTERNAL FACTORS

5.1.1 Political Factors

New political deployments and legislations, may lead to substantial changes in the Department. If changes are not implemented within the Department, they may have a detrimental impact on the provision of Health care services. Additionally, new mandates and policies may require the Department to review its strategic objectives. The challenge is that some of the new mandates might be difficult to achieve without adequate resources. This is, therefore, viewed as a threat to the Department. Alternatively, the new mandates might move the Department forward as employees may be required to change their way of doing things.

5.1.2 Economic Factors

High interest rates, unemployment rates, inflation rates and tax revenues have a negative impact on the Department. In view of these economic trends, it might be difficult to achieve the Department’s strategic objectives. The Department might be unable to acquire drugs, medical supplies, and even to recruit the required skills due to the above mentioned economic factors. The impact of these factors will, therefore, have a negative impact on the Department if weaknesses internal to the Department are not identified and completely addressed.

5.1.3 Social Factors

Limpopo province is almost 80% rural, and most of the communities are faced with poverty. Increasing infections related to HIV and AIDS in the communities will put severe pressure on the Department as the Department is faced with the shortage of Health Professionals. The extent of migration or loss of Health Professionals is difficult to quantify. However, the effects of this are multifaceted and have far reaching consequences for both the economy and the maintenance of health services in the Department. Furthermore, the effects of “brain drain” limits service delivery and general population’s access to health services.

Population movement from other countries into the Province poses the greatest challenges for the Provincial Government’s planning, service provision, and social cohesion. This is viewed as a threat to the Department as it will have to provide Health Care Services to the increased population due to population movement into the Province.

The above mentioned social factors are particularly evident where understaffing leads to personnel utilised outside their scope of practice, unethical conducts, low morale, and create high-risk environment for the patient, employees and employer.

5.1.4 Technological Factors

Technological advancement will require that the Department trains its existing employees or recruit new employees with the required skills. The challenge is that the required skills might not be available in the external and internal labour market due to excessive demand for IT personnel. The implication is that implementation of new systems within the Department might be delayed or not supported due to lack of the required skills.

By contrast, introduction of new systems might simplify processes and procedures in the Department and enable the Department to achieve its strategic objectives. For instance, implementation of Telemedicine has the following benefits:

BENEFITS OF TELEMEDICINE

|BENEFITS |ELABORATION |

|Advancements in delivery of services. |Certain health services can be greatly enhanced via |

| |telemedicine. For instance, rural patients can now have access |

| |to specialists. |

|Workforce development / jobs |Local healthcare facilities will be equipped with advanced |

| |telecommunications services for telemedicine purposes and will |

| |then share the videoconferencing capability in a partnership |

| |with educational institutions to train more local people for |

| |jobs in health care that are available locally. |

|Quality of life and longevity gains are worth a lot. |Use of telemedicine can have a significant impact on individual|

| |health and can therefore, favourably impact longevity. |

|Access to quality healthcare |Access to quality healthcare in underserved areas, such as |

| |rural communities, is one of the most important promised |

| |benefits of telemedicine. |

|Saves time, travel and other expenses. |There is an opportunity for transportation cost savings, such |

| |as the potential for saving a portion of the millions spent |

| |annually on patient automobile travel expenses, emergency air |

| |evacuations or other forms of transporting patients across the |

| |large expanses of rural South Africa. |

|Accuracy of diagnosis / reduction of medical errors. |Reduction of medical errors is a huge concern for the medical |

| |community. With “tele-assistance”, it is hoped that it will be |

| |easier for a doctor to get a “second opinion” on their |

| |diagnosis of a patient. |

|Continuing Medical Education / Lifelong learning |Telemedicine can enhance educational opportunities for health |

| |care providers, patients, and families, improving clinical |

| |outcomes and reducing hospitalizations. |

Source:

5.1.5 Environmental Factors

Approximately 80% of the population lives in rural settlement. This kind of environment greatly dictates the nature of their lives that might impose threats to their well-being. According to the Departmental reports, Vhembe and Mopani Districts are facing high number of malaria infections due to their environments. This is an issue of serious concern for the Department because malaria has a negative effect on the well-being of the population.

High malaria morbidity cases, therefore, implies that the Department increases its investment in malaria prevention and treatment, as this is crucial for the well-being of the population.

5.1.6 Legal Factors

Acts of parliament, draft bills, regulations and white papers as per paragraph 2.4 above, provide the mandate to all departments. The law makers would amend certain legal mandates in order to improve service delivery. This may require the Department to also review its existing internal policies to comply with the new/amended regulations. This would imply that the required skills especially for policy making and implementation be continuously improved. Alternatively, reviewing of the existing policies might bring opportunities for the Department and lead to improvement in the provision of Health Care services.

5.2 APPLICABLE INTERNAL FACTORS

5.2.1 Rural allowance and Occupational Specific Dispensation (OSD) as incentives to attract recruit and retain Health Professionals:

The introduction of the Rural Allowance and Occupational Specific Dispensation (OSD), which is a National Department of Health’s efforts to recruit and retain Health Professionals, does not give the Province a competitive urge over other Provinces, since this is implemented across government. This is supported by the fact that during 2010/2011, according to the Department’s Annual Report for the specified period, the Department lost 18 percent of Medical Specialists, 11 percent of Dentists, and 25 percent of Allied Health Professionals, just to mention a few.

Implementation of Rural Allowance in the Department has a negative effect especially in the institutions where it is not implemented. Health Professionals in the institutions where this allowance is not implemented are of the view that Limpopo Province is 100% rural, and therefore, they suggest that rural allowance be implemented in all the intuitions.

Based on the above, this strategy is designed to respond to the challenges facing Health Professionals such as the ones identified in the preceding paragraphs.

5.2.2 Bursary Awards as Recruitment and Retention strategy:

Awarding of bursaries to health professionals is one of the departmental strategies to recruit health professionals in the Department. However, the challenge is that, after completion of their studies, students opt to terminate their contracts with the Department instead of serving their contractual service obligations. This challenge provides an opportunity to explore the possibility of evaluating bursary strategies, to ensure that all identified gaps are properly attended to. This Recruitment and Retention strategy examines amongst others, the role of bursaries in the retention of Health Care Professionals, and discusses the impact of the use of bursaries in reducing staff turnover rate within the Department of Health.

5.2.3 HRD and Training as retention strategy

The department has developed HRD and Training strategy, such as learnerships as a tool to address the skills gaps within the department. However, many trained health professionals are leaving the Department for other greener pastures, which leads to brain drain. This recruitment and retention strategy will identify mechanisms to ensure that career mobility is strengthened within the department.

5.2.4 Performance Management and Development System

The Department is currently implementing performance management and development system to monitor employees’ performance and reward good performance, and to address employees’ developmental needs. However, the system is still subject to manipulation in that most employees view it as financial rewarding system than managing performance.

5.2.6 SUMMARY OF THE STATE HOUSING POLICY

In terms of the State Housing Policy, par. 1.1, preference will be given to the obligatory (e.g. Doctors, Specialists) when providing State Housing. Par.1.3, states that the Department of Health has made state houses available to only Essential Healthcare workers. This is available on an appropriate rental especially in circumstances where certain work activities of the state necessitate the provision thereof and / or where it is in the interest of the state. Par.1.4, portrays that utilisation of state housing under these circumstances should not be regarded as a service benefit but as a work facility.

In addition, Par.7.1, stipulates that the Department of Health is responsible for the maintenance and repairs of all State Housing, which are purchases or erected, as well as the permanent fixtures. In terms of Par. 7.2, the Department of Health is responsible for the cleaning of the interior and exterior (i.e. Gardens and Grounds) that form part thereof.

5.2.7 SUMMARY OF DEPARTMENTAL BURSARY POLICY

In terms of Par 8.1.1, of the current Departmental Bursary Policy, applicants must be permanent residents of Limpopo Province. Par. 8.1.4, stipulates that preference will be given to applicants who were historically disadvantaged from designated groups who meet minimum requirements (deep rural). Additionally, Par. 8.1.5, stipulates that selection has to ensure equitable distribution of bursaries in line with population and modality of districts.

In terms of Par. 4.1.7 of the Bursary Agreement Undertaking, the bursary holders on completion of the course undertakes to serve exclusively the Department for a continuous / uninterrupted period within a month at any institution nearest to the initial domicilum citandi et executandi of the bursar in any capacity for which the Department may consider the bursar suitable within the field of study as part of service obligations in terms of the agreement.

Par. 4.1.8 of the Bursary Agreement Undertaking stipulates that should the bursar fail to honour bursary service obligation in terms of the Bursary Agreement, he/she must repay immediately the bursary amounts paid to the academic / tertiary institution on his / her behalf in terms of clause 3.1.1 (c) of the Bursary Agreement plus interest on the amounts at the ruling rate of interest applicable from time to time to debts due to the Department, as determined by or in terms of the relevant financial prescripts of the National Treasury, calculated from the date on which the obligation to pay arose in terms of clause 3.1.1 (e) of the Bursary Agreement.

The table below shows field of studies which are supported by the Departmental Bursary Policy (Bursary allocations in terms of numbers and estimated cost are reflected in table 8.1.2, in pages 40-41):

| | |

|NUMBER |FIELD OF STUDY |

|1. |MBCHB |

|2. |Cuban Medical Scholarship |

|3. |BDS |

|4. |Pharmacy |

|5. |Occupational Therapy |

|6. |Physiotherapy |

|7. |Dietetics |

|8. |Speech and Hearing |

|9. |Orthotic/Prosthetic |

|10. |Clinical Engineering |

|11. |Dental Therapy |

|12. |Podiatry |

|13. |Optometry |

|14. |M.A Clinical Psychology |

|15. |Nutrition |

5.2.8 STAFF TURN OVER RATE TRENDS

|Occupational Classification |2008/09 |2009/10 |2010/11 |

| | | | |

| |Filled |

|Advertising positions with poor responses |Positions for Medical Officers, Medical Specialists, and |

| |Registrars have poor responses when advertised due to shortage |

| |of qualified applicants. |

|Rural and urban imbalances |That is inequitable distribution of Health Professionals in |

| |urban and rural areas. |

|Leadership and Management style |Poor management style (attitudes of some managers against |

| |Health Professionals) in some institutions. |

|Lack of opportunities for professional development |Some Health Professionals are not given opportunities for |

| |professional development within the Department. |

|Financial Consideration |Health Professionals moving to other provinces due to |

| |attractive packages in those provinces, such as Gauteng and |

| |KZN. |

|Lack of office space, and residential accommodation |There is shortage and or inadequate residential accommodation |

| |for Health Professionals in some of the Institutions. |

|FACTORS |ELABORATION |

|Shortage of equipment |For instance, Medical Equipment. |

|Poor working conditions |Due to old equipment in some Institutions, and old |

| |infrastructures. |

|Unclear roles and responsibilities |Due to lack of support for the development of job description. |

|Inadequate management of Remunerated Work outside Public |Some of the Departmental Health Professionals practice work |

|Service |outside Public Service, and this is not properly managed. |

|Non-Implementation of Cellphone Allowance for Health |No cellphones at the institutions for Health Professionals |

|Professionals on call and standby. |(such as Medical Officers) on duty or standby. |

|Inadequate support from HR Personnel |Delays in addressing issues such as payment of acting |

| |allowance. |

|Discrepancy in the Implementation of Rural Allowance in the |Due to the fact that Limpopo is considered to be 80% Rural, and|

|Department. |20% Urban. |

5.2.8.2 EXAMPLES OF WHAT SOME HEALTH PROFESSIONALS SAY ON EXIT INTERVIEWS.

|QUESTIONS |RESPONSES |

|What was most satisfying about your job? |I enjoy to be working in theatre, more especially in the operating room. I love to be |

| |next to the patient. |

|Was your workload fair? Yes / No. If No what can be done|The supervisor must learn to improve the delegation of Job, because they want us to do |

|to improve the situation? |each and JOB coming our way. This puts us under extremely pressure to deliver quality |

| |work. |

|Were your Key Results Areas, Key Results Indicators and |Yes, but our supervisors want us to do the jobs above our scope of practice and they |

|Targets in your Performance instrument / Performance |don’t cover us. |

|Agreement addressed? Yes / No, please explain why below.| |

|Were quarterly reviews with your supervisor conducted as|Yes, but the problem is that they don’t want to assist us with were we are failing to |

|agreed in the performance instrument / Performance |comply. But yet they want to rate us at the end of the quarter. |

|Agreement? Yes / No. If No, please explain why? | |

|Were your duties clearly defined? Yes / No. Was the job |No, if there is a problem in other sections, supervisors want us to go and do that |

|description accurate? Yes / No, if No, please explain |particular job. |

|why? | |

|Did your duties turn out to be as expected? Yes / No. If|No, the issue is that our supervisors want to give us with lot of work which is |

|No, please explain why? |stressing. These days we do lot of paper work than patient care. |

|Did you receive enough training / adequate support (both|Yes, but the problem is that at the in-service training at our institution, they |

|on the job and specialised) to perform your job |allocate professional nurses to go and attend in-service training. We are not given |

|effectively? Yes / No, if No, please explain why? |equal opportunity to attend in-service training. |

|Were you satisfied with the department‘s performance |Not at all, our department should hire the appropriate people to do the job e.g. washing|

|review system? If No what can be done to improve the |of instrument. |

|situation? | |

|Any other things you need us to know about the |The problem is that people are getting old without proper training to deliver quality |

|institution including the management? |health services. Other employees have potential to teach, like myself I can teach my |

| |community with what I have gained with regard to health issues. There is a lot of stress|

| |which is caused by some supervisors because they don’t want to take responsibility, and |

| |they don’t handle issues in a right way. They always want us to make mistakes so that |

| |they can suspend us or take us to hearing which is not good. |

6. BEST PRACTICES AS RECOMMENDED BY WORLD HEALTH ORGANISATION (WHO REPORT 2006):

|QUESTIONS |RESPONSES |

|6.1 Workforce: Enhancing performance |Strategies to improve the performance of the health workforce must initially be focused on existing |

| |staff because of the time lag in training new health workers. |

| |Substantial improvements in the availability, competence, responsiveness and productivity of the |

| |workforce can be rapidly achieved through an array of low-cost and practical instruments. |

|6.2 Supervision makes a big difference |Supportive, yet firm and fair supervision is one of the most effective instruments available to improve|

| |the competence of individual health workers, especially when coupled with clear job descriptions and |

| |feedback on performance. Moreover, supervision can build a practical integration of new skills acquired|

| |through on-the-job training. |

|6.3 Fair and reliable compensation |Decent pay that arrives on time is crucial. The way in which workers are paid, for example, salaried or|

| |fee-for-service, has effect on productivity and quality of care that require careful monitoring. |

| |Financial and non-financial incentives such as study leave or child care are more effective when |

| |packaged, than when provided on their own. |

|6.4 Critical support systems |No matter how motivated and skilled health workers are, they cannot do their jobs properly in |

| |facilities that lack clean water, adequate lighting, heating, vehicles, drugs, working equipment and |

| |other supplies. Decisions to introduce new technologies for diagnosis, treatment or communication |

| |should be informed in part by an assessment of their implications for the health workforce. |

|6.5 Lifelong learning should be inculcated |This may include short-term training, encouraging staff to innovate, and fostering teamwork. |

|in the workplace |Frequently, staff- devises simple but effective solutions to improve performance and should be |

| |encouraged to share and act on their ideas. |

|6.6 Exit: Managing migration and attrition |Unplanned or excessive exits may cause significant losses of workers and compromise the system’s |

| |knowledge, memory and culture. In some regions, worker illness, deaths and migration, together, |

| |constitute a haemorrhaging that overwhelms training capacity and threatens workforce stability. |

| |Strategies to counteract workforce attrition include managing migration, making health a career of |

| |choice, and stemming premature sickness and retirement. |

| |Managing migration of health workers involves balancing the freedom of individuals to pursue work where|

| |they choose, with the need to stem excessive losses from both internal migration (urban concentration |

| |and rural neglect) and International movements from underdeveloped to developed countries. |

| |Some international migration is planned, for example, the import of professionals into the Eastern |

| |Mediterranean Region, while other migrations are unplanned with deleterious health consequences. For |

| |unplanned migration, tailoring education and recruitment to rural realities, improving working |

| |conditions more generally and facilitating the return of migrants represent important retention |

| |strategies. Richer countries receiving migrants from poorer countries should adopt responsible |

| |recruitment policies, treat migrant health workers fairly, and consider entering into bilateral |

| |agreements. |

| |Health work as a career of choice: majority of health workers are women and “feminisation” trends are |

| |well established in the male dominated field of medicine. To accommodate female health workers better, |

| |more attention must be paid to their safety, including protecting them from violence. Other measures |

| |must be put in place. These include more flexible work arrangements to accommodate family |

| |considerations, and career tracks that promote women towards senior faculty and leadership positions |

| |more effectively. |

| |Ensuring safe work environments: Outflows from the workforce caused by illness, disability and death |

| |are unnecessarily high and demand priority attention, especially in areas of high HIV prevalence. |

| |Strategies to minimise occupational hazards include the recognition and appropriate management of |

| |physical risks and mental stress, as well as full compliance with prevention and protection guidelines.|

| |Provision of effective prevention services and access to treatment for all health workers who become |

| |HIV-positive are the only reasonable way forward in the pursuit of universal access to HIV prevention, |

| |treatment and care. |

| |Retirement planning: In an era of ageing workforces and trends towards earlier retirement, unwanted |

| |attrition can be stemmed by a range of policies. These policies can reduce incentives for early |

| |retirement, decrease the cost of employing older people, recruit retirees back to work and improve |

| |conditions for older workers. Succession planning is central to preserving key competencies and skills |

| |in the workforce. (World Health Organisation (WHO) Report 2006) |

|RELEVANCE OF THE WHO RECOMMENDATIONS TO THE DEPARTMENTAL RECRUITMENT AND RETENTION STRATEGY |

• Implementation of this strategy will assist the Department in improving the performance of the existing Health Professionals as one of the best practice recommended by World Health Organisation.

• Firm and fair supervision in the Department will be strengthened as this is, according to World Health Organisation, one of the most effective instruments available to improve the competence of individual health workers.

• This Recruitment and Retention Strategy will give the Department an opportunity to enhance its existing processes in terms of rewarding Health Professionals, and recognising the contribution they make.

• The implementation of this strategy will ensure that Staff involvement as a key factor influencing staff moral in the Department, will be effectively maintained at all levels in the Department, through adequate communication at all levels.

• The strategy will also encourage flexible working patterns, flexible working careers as one of the best practice recommended by the World Health Organisation. Additionally, the strategy will help the Department to continue to work creatively to meet the needs of Health Professionals and patients / communities.

• Safe working environment as one of the best practices to retain Health Professionals will be ensured.

7. STRATEGIC INTERVENTIONS TO CLOSE IDENTIFIED GAPS

|7.1 GOAL: STRENGTHEN RECRUITMENT OF HEALTH PROFESSIONALS |

|Output |Indicator |Activity |Outcomes |

|Strengthened Recruitment of Health |Number of health professionals |Advertisement of posts |Improved health service |

|professionals in the Department. |recruited in the Department. |The advertisement of posts will be posted in the|delivery in the Province. |

| | |media coverage in order to reach diverse | |

| | |applicants identified as follows: | |

| | |Print media such as newspapers. | |

| | |Journals such as: | |

| | |Medical journals | |

| | |Nursing journals | |

| | |Pharmacy journals | |

| | |Electronic media: | |

| | |On line recruitment | |

| | |Radio slots | |

| | |Open advertisement for recruitment of Health | |

| | |professionals whereby qualified individuals can | |

| | |present themselves directly at various | |

| | |institutions for appointment after screening | |

| | |process has been done. | |

|Health professionals recruited through |Number of health professionals |Medical Doctors are recruited through Government|Improved health service |

|Government to Government contract |recruited in the Department. |to Government contract from Cuba, Tunisia and |delivery in the Province. |

| | |Iran. | |

| | |This is done through the National Department of | |

| | |Health. | |

|Facilitate the return of Health |Number of returns of health |This can be achieved through the utilization of |Improved health service |

|professionals |professionals recruited and retained |South African Embassies of the host countries. |delivery in the Province. |

| |in the department |For Health professionals returning from local | |

| | |and outside the country remuneration could be | |

| | |based on the recognition of current and previous| |

| | |experience. | |

|Output |Indicator |Activity |Outcomes |

|Health professionals recruited through |UNV medical doctors; |The UNDP assist the Department through |Improved health service |

|United Nations Volunteer Programme (UNV) |UNV clinical engineers |recruitment and placement of United Nations |delivery in the Province. |

| |UNV pharmacists; and |Volunteer health professionals to accelerate | |

| |UNV specialist Nurses recruited and |transfer of skills and development of local | |

| |placed within the health facilities |practitioners to improve the delivery of service| |

| | |in the Province. | |

|Awarding of bursaries to study in health |Number of bursaries awarded |Review the Departmental Bursary Policy, to bind |Bursary Holders Retained |

|related professional fields. | |the bursary holders. | |

| | | |Improved health service |

| | | |delivery in the Province. |

|Awarding of Learnerships |Number of learnerships awarded |The Department, as a recruitment measure awards |Improved health service |

| | |learnerships in various health related training |delivery in the Province. |

| | |fields whereupon completion the learners are | |

| | |absorbed in the system | |

|Marketing of hospitals |Hospital profiles developed |Development of Marketing Strategy. |Improved health service |

| | |Updating of the Departmental website. |delivery in the Province. |

| | |All hospital profiles to be posted on the | |

| | |Departmental website. | |

| | |Hospital newspapers and video/DVD clips to be | |

| | |played on hospital TV’s. | |

|GOAL: RETENTION OF HEALTH PROFESSIONALS |

|Output |Indicator |Activity |Outcomes |

|7.2.1 Rural Allowances |Rural Allowances implemented equally |Implement Rural Allowances equally to all |Health Professionals |

| |to all Medical Officers, Medical |Medical Officers, Medical Specialists, |attracted, recruited and |

| |Specialists, Dentists, Registrars and|Dentists, Registrars and Pharmacists. |retained |

| |Pharmacists. | | |

|7.2.2 Cell Phone Allowance |One cell phone at each institution |Review current cell phone policy. |Health professionals |

| |for Health Professionals on call or |Implement reviewed cell phone policy. |attracted, recruited and |

| |standby. | |retained |

|7.2.3 Strengthening Implementation of |OSDs implemented across all Health |Implement reviewed salary packages aligned to|Health Professionals |

|OSDs |Categories. |OSDs across all Health Categories. |attracted, recruited and |

| | | |retained. |

|7.2.4 Infrastructures Improvement |Improved infrastructures |Implement hospitals revitalisation |Health Professionals |

| | |programmes. |attracted, recruited and |

| | |Purchase required equipment in the hospitals.|retained. |

|7.2.5 Staff Accommodation |Fully furnished staff accommodation |Conduct assessment on the existing staff |Health Professionals |

| |for Health Professionals. |accommodation. |attracted, recruited and |

| | |Compile a report with recommendations. |retained. |

| | |Implementation of the recommendations. | |

| | | | |

|7.2.6 Recreational facilities |Increased number of recreational |Conduct an audit on the existing recreational|Health Professionals |

| |facilities at the hospitals. |facilities at the hospitals. |attracted, recruited and |

| | |Compile a report with recommendations. |retained. |

| | |Implementation of the recommendations. | |

|7.2.7 Hospital resource centres |Fully equipped hospital resource |Establish fully equipped hospital resource |Health Professionals |

| |centres. |centres with computers and clinical reference|attracted, recruited and |

| | |material. |retained. |

|Output |Indicator |Activity |Outcomes |

|7.2.8 Strengthening Security measures at |Increased number of safe health |Provide 24 hours of effective security and |Safety of personnel and |

|the health facilities. |facilities. |effective coverage of the facilities and |property ensured. |

| | |premises. | |

| | |Maintain and record all occurrences in the | |

| | |occurrence register and pocket books. | |

| | |To conduct regular checks / patrolling duties| |

| | |around the premises as required. | |

| | |Guarding the premises against intrusion on | |

| | |unauthorised entries. | |

| | |Maintain a high standard of disciplines and | |

| | |smartness in appearance at all times. | |

| | |Palisade fence at all health facilities. | |

| | |Installation of surveillance cameras at | |

| | |sensitive points. | |

| | |Appointments of ground man to maintain the | |

| | |grounds in the institution. | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

8. RECRUITMENT PLAN

8.1.1 HR PROJECTIONS AND COSTS

|Job Title |Approved posts |

|Senior General Manager |Corporate Services |

|Senior General Manager |Health Branch |

|Chief Financial Officer |Finance |

|General Manager |Human Resource Management and Development |

|General Manger |Budget |

|Senior Manager |Human Resource Development |

|Senior Manager |Human Resource Management |

|Senior Manager |Human Resource Planning, Research & Product Development |

|Senior Manager |Security |

|Senior Manager |Infrastructure Development |

|Senior Manager |OD & Efficiency |

|Senior Manager |Labour Relations |

|Senior Manager |Risk Management |

|Senior Manager |Strategic Planning |

|Head of Monitoring and Evaluation |Monitoring and Evaluation |

2. Quarterly and Annual Reports will serve as a means of verification. Additionally, efforts to address any deviations will be identified, and where necessary actions for rectification will need to be taken.

9. IMPLEMENTATION PLAN

| | | |

|PRIORITY INERVENTIONS |KEY |EXPECTED |

| |ACTIVITIES |OUTCOMES |

| | | |

|R4,624,012,000 |R447,320,502 |R668,860,000 |

Additionally, the Department anticipates spending the budget reflected in the table below for partial implementation of this strategy:

|Appointments for Health Professionals |Awarding of Bursaries |Infrastructure Development |

|2011/12-2013/14 |2011/12-2013/14 |2011/12-2013/14 |

| | | |

|R469,018,635 |R56,478,272 |R547,104,000 |

GAP (DEFICIT) TO FULLY IMPLEMNT THE STRATEGY:

|Appointments for Health Professionals |Awarding of Bursaries |Infrastructure Development |

|2011/12-2013/14 |2011/12-2013/14 |2011/12-2013/14 |

| | | |

|R4,154,993,365 |R390,842,230 |R121,756,000 |

10. IMPACT OF THE RECRUITMENT AND RETENTION STRATEGY ON SERVICE DELIVERY.

The revised strategy due to financial constraints will have the following impact:

1. Transformation and modernisation of infrastructure and equipment at health institutions may not be achieved;

2. Management systems, structures and processes may be affected;

3. Inadequate staff accommodation at health institutions which may result in high staff turnover;

4. Health Professionals’ skills / competencies may not be achieved as planned in terms of the Human Resource Development Strategy;

5. Number of posts to be filled in terms of Human Resource Plan may not be achieved, this might result into workload, eventually into burnouts and employee stress;

6. Patients waiting time at the health institutions will remain a challenge; and

7. High staff turnover rate will remain a challenge.[pic]

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