WHERE HAVE ALL THE DOCTORS GONE?

This project is a joint venture between the Foundation for Professional Development (Pty) Ltd

and the Rural Health Initiative

WHERE HAVE ALL THE DOCTORS GONE?

AFRICA HEALTH PLACEMENTS





NO TEAM = NO GAMEANYONE WANT TO DISPUTE?

=





CONTENT

CURRENT SITUATIONSO HOW DID WE GET HERE?SOLUTIONSPOTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDsAFRICA HEALTH PLACEMENTSGREAT EXPECTATIONS





(WH0, 2006)

SA IN CONTEXT:HOME AND AWAY

US

A

Sou

th A

frica

Pub

lic +

Priv

ate

Sou

th A

frica

Pub

lic S

ecto

r

Sou

th A

frica

Rur

al P

ublic

Doc

tors

per

100

000

Pop

ulat

ion





SA IN CONTEXT:QUADRUPLE BURDEN OF DISEASE





INEQUITIES IN HEALTHCARE DELIVERY:PUBLIC SECTOR v PRIVATE SECTOR

POPULATION SERVED BY PUBLIC AND PRIVATE HEALTHCARE SECTORS

PUBLIC, 34,611,781,

82%

PRIVATE,7,597,709,18%

NUMBER OF GPs SERVING PUBLIC AND PRIVATE SECTORS

PUBLIC,5,406, 27%

PRIVATE, 14,323, 73%

SAHR 2004





INEQUITIES IN HEALTHCARE DELIVERY:RURAL v URBAN

208

339

15 277

60

0

50

100

150

200

250

300

350

Gau

teng

Wes

tern

Cap

e

Nor

th-

Wes

t

Nor

ther

nC

ape

Mpu

mal

.

KZN

(Urban v Rural Provinces)SPECIALISTS PER MILLION UNINSURED POPULATION

Van Rensburg & Van Rensburg, 1999





• Despite having the largest health professional production capacity in Africa, we have ended up with a:– Massive shortage of clinical staff in the public sector– Massive shortage of clinical staff in rural areas

• This while demands on the health care system are rapidly escalating

CURRENT SITUATION:IN A NUTSHELL





CONTENT






A GLOBAL COMPETITION FOR RESOURCES:GLOBALISATION KILLED THE MEDICAL STAR

SA Med School Intake

p.a.

NZ Canada UK USA Est Public Sector Vac

0500

10001500200025003000350040004500

Number of SA Doctors in…

OECD 2003





A GLOBAL COMPETITION FOR RESOURCES: BRAIN DRAIN: CUMULATIVE TOLL – WE ARE LOSING

Total Docto

rs Produce

d in SA

Doctors

Registered in

SA

Doctors

NOT regis

tered in SA

Est Public

Secto

r Vac

040008000

120001600020000

1990 – 2005

Financial Mail April 2006





A GLOBAL COMPETITION FOR RESOURCES: BRAIN DRAIN: CAN WE ALSO EXPORT OUR INDIGENT?

There are more SA qualified doctors working abroad than the total number of doctors working

in the public sector in SA





NO TEAM = NO GAME:RELEGATION ZONE…





1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 20070

200

400

600

800

1000

1200

1400

8 Medical School’s Annual Static Intake – 12 YearsPopulation growth in same period from 40.5 million to 47.9 million

PRODUCTION:A SIMPLE TREND





1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 20070

200

400

600

800

1000

1200

1400

PRODUCTION:A SIMPLE TREND

BUT:• Growing population• Increasing brain drain• Changing demographics impacting

on number of “doctor hours”• Number of final graduates is

declining





SAMA Survey 2003

RETENTION:ITS HOW YOU TREAT THEM, STUPID!

incompetent/autocratic/waste10%

Professional issues / nursing not good9%

Academic collapse/ Insufficient funds for specialities/research2%

targeted by govt/ increasing legislation2%

stress / need quality of life/fed up/insecurity6%

Other8%

abused by mgment / no recognition/lack of respect21%

State not attractive option/ disfunctional/ workload/lack future/admin load16%

Not enough salary/ no increase/ cant cope financially15%

h/care not delivered / affordable/failing/basics not there11%





CONTENT






• 70 of 300 US citizens who won Nobel Prizes since 1901 are foreign

• Sun Microsystems, Intel, Google – all foreign founders

• 40% of US PhDs in Science and Engineering go to foreigners

• US planning to recruit 500 000 health professionals in next decade.

LESSONS FROM A GLOBAL WINNER:USA - A SUPER-POWER BUILT ON FOREIGN SKILLS

The Economist, 10 April 2008





• NHS staffing crisis 2000• NHS overstaffed 2008

– Increased number of medical schools,– Opened doors to internationally qualified staff– Actively recruited former staff not working in the NHS– Improved retention– Offered flexible retirement

LESSONS FROM A GLOBAL WINNER:THE UK NHS CASE STUDY 2000 - 2008





CONTENT






POTENTIAL SOLUTIONS – PRODUCTION:IMMEDIATE AND MEDIUM-TERM SOLUTIONS

IMMEDIATE SOLUTION:What do the current 8 medical universities need?

MEDIUM-TERM SOLUTION:Private Sector Medical Schools





CONTENT






POTENTIAL SOLUTIONS – RETENTION:I DON’T THINK THEY ARE COMING BACK…

0

200

400

600

800

1000

1200

140019

54

1956

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

RSA Male RSA Fem

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 20070

200

400

600

800

1000

1200

1400

8 Medical School’s Annual Intake – 12 Years





POTENTIAL SOLUTIONS – RETENTION:SOLUTIONS THAT TAKE RESPONSIBILITY

• BEST PRACTICE HUMAN RESOURCE MANAGEMENT

• MAXIMISE USE OF BURSARY SYSTEM

• ACTIVE RECRUITMENT





CONTENT






POTENTIAL SOLUTIONS – FOREIGN DRS:FQDs AS A SOURCE OF SKILLS

85%

15%

Foreign Doctors Working in SA - Current Status

Local Qualified Foreign Qualified

75%

25%

Foreign Doctors Working in Developed Countries - Av-

erageLocal Qualified Foreign Qualified

95%

5%

Foreign Doctors Working in SA – NDOH Policy Target

Local Qualified Foreign Qualified





POTENTIAL SOLUTIONS – FOREIGN DRS:CHEAPER THE PRICE!

Training 1 SA Dr Recruiting 1 Foreign Dr (AHP)0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

RELATIVE COST OF TRAINING DOCTOR v RECRUITING FOREIGN-QUALIFIED DOCTOR

Cost

– R

and

Valu

e





POTENTIAL SOLUTIONS – FOREIGN DRS:A SOLUTION IS PARKING YOUR CAR

Reconsider: This is working to SA and Africa’s detriment!

POLICY





POTENTIAL SOLUTIONS – FOREIGN DRS:A GLOBAL COMPETITION FOR SCARCE RESOURCES

• WE HAVE A COMPETITIVE ADVANTAGE:– LIFESTYLE! – WORK EXPERIENCE! – HUMANITARIAN APPEAL!

• SIMPLIFY AND SPEED UP REGISTRATION PROCESS WITH REGULATORY BODIES

• RETHINK AFRICAN RECRUITMENT POLICY• GLOBAL BEST PRACTICE IN RECRUITMENT

• ACCOMMODATION





CONTENT






A WORKING STAFFING SOLUTION MODEL FOR SOUTHERN AFRICA

• Operating since 2005• Nearly 700 health workers placed in South Africa

since inception– doctors, nurses, allied health workers, lay health

workers, clinic support staff, management– Foreign- and local-qualified professionals– In 2008: AHP will place 4 times the number of foreign

qualified doctors in rural SA as all 8 SA medical schools combined (approx 140 doctors).





AHP PERFORMANCE IN PERSPECTIVE

50%600 Drs

25%150 Drs

8 SA Medical Schools = 1200 Graduates p.a.

50% 75% 75%

25%35 Drs

Remain in SA Remain in Public Service Remain in Rural Service

140 Drs in 2008





NET#WORK BBDO

WORKING AS PART OF A NETWORK:PARTNERSHIPS ARE CRITICAL





AFRICA HEALTH PLACEMENTS:BECOMING MORE COMPETITIVE IN THE GLOBAL MARKET

TIME TO PLACEMENT – FOREIGN-QUALIFIED DOCTORS

20051.5

Years

2008 - Average4 - 6

Months

2008 - Australia

1 Month





CONTENT






GREAT EXPECTATIONS:POLICY RECONSIDERATIONS

• BEST PRACTICE HUMAN RESOURCE MANAGEMENT• ACTIVELY PURSUE RECRUITMENT AGENCY SERVICES• SIMPLIFY AND REDUCE TIME FOR REGISTRATION• RETHINK AFRICAN RECRUITMENT• ACCOMMODATION FOR RURAL HOSPITALS

COMMISSION TO REVIEW RECRUITMENT AND RETENTION IN SA

PUBLIC SECTOR

RECOGNISE WE ARE COMPETING IN A GLOBAL MARKET FOR A SCARCE AND

MOBILE RESOURCE





GREAT EXPECTATIONS:WHAT WE NEED TO DO



QUESTIONS?

PREPARED BY: Saul Kornik

Director, [email protected]

Foundation for

Professional Development

WHERE HAVE ALL THE DOCTORS GONE?

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