Chapter 1 Introduction and Overview of the Study

NO / ITEMS / PAGE NO
1 / External and Internal Stakeholders and their
responsibilities / 4-5
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
Recruitment and Retention Strategy / 19
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)
Relevance of the WHO recommendations to the Departmental Recruitment and Retention Strategy / 31
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 byMs. 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 Mafubeluin 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

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
Head of Department /

Is accountable for the overall management of Recruitment and Retention Strategy.

Executive Management /

Providing strategic direction and monitoring the implementation of the Recruitment and Retention Strategy.

Senior Management Service /

Ensuring compliance with Recruitment and Retention Strategic within their respective Divisions.

Districts and Institutions Management Services /

Ensuring compliance with Recruitment and Retention Strategy within the District Offices and Institutions.

Managers /

Are individually and collectively responsible for the implementation, management, monitoring and evaluation of the Recruitment and Retention Strategy in their respective Business Units.

Labour /

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

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.

2.1BACKGROUND

a)Population Profile
FIGURE 1

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.
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%).

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

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).

2.2VISION

An optimal and sustainable health care service in Limpopo

2.3MISSION

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

2.4LEGAL 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

2.5OTHER 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):

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:

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

2.6ALIGNMENT 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.

2.7DEPARTMENTAL PROGRAMMES

2.7.1PROGRAMME 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.

2.7.2PROGRAMME 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).

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 governance system by 2014. / Support the implementation of the Departmental plans and programs to improve service delivery. / Improve quality of health services by 2014.
Strategic goal / Goal statement / Rationale / Expected outcomes

Appropriate human resources management and development provided.

/ Ensure appropriate HRM and development services by 2014. / A need to optimise the realisation of the strategic objectives of the Department through human resource management and development services. / Improve realisation of the Department’s objectives.

Sound financial management practice promoted.

/ Ensure efficient and effective financial and supply chain management by 2014. / A need to ensure fiscal discipline and optimisation of resource allocation. / Improved accountability on financial resources resulting in well-funded and managed health services.

Implementation of comprehensive care and management of HIV and AIDS, TB, STIs and other communicable diseases accelerated.

/ Develop and implement plans for the provincial priority programs by 2014. / A need to reduce morbidity and mortality related to the burden of diseases. / Reduce morbidity and mortality.

Decreasing Maternal and Child mortality.

/ Ensure implementation of programmes targeting women and children. / A need to reduce morbidity and mortality in pregnant women and children. / Reduced morbidity and mortality.
Strategic goal / Goal statement / Rationale / Expected outcomes

Strengthen District health and hospital services.

/ Implement 80% of DHS components in all districts and sustainable outreach programme at all levels of care by 2014. / A need to ensure equitable access to health care services. / Improved access to health services.

Improve quality of health care.

/ Implement quality improvement plans in the districts and hospitals by 2014. / Improve client satisfaction and clinical outcomes. / Reduced morbidity and mortality in the province.
Improved client satisfaction and patient safety.

Improve Emergency Medical Services.

/ Ensure that 90% of EMS calls are responded to within nation norm of 15 minutes in rural areas and 40 minutes in urban areas by 2014. / A need to respond to calls within the norm in order to save lives. / Reduce morbidity and mortality in the province.

Tertiary services development.

/ Tertiary/academic services increased from 22 to 37 in line with the Modernisation of Tertiary Services Document. / Improved and increased access to tertiary services in the province.
Developed teaching platform in the province.
Reduced referrals to other provinces. / Increased access to tertiary services.
Strategic goal / Goal statement / Rationale / Expected outcomes
10 Improve infrastructure development and maintenance / Implement a reviewed 5 year infrastructure development and maintenance plan by 2014. / Health services delivery needs for additional infrastructure expansion. / Improved access and quality of health services.

STRATEGIC OBJECTIVES OF THE RECRUITMENT AND RETENTION STRATEGY:

To identifybest 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 identifystrategies and mechanisms that can be used and applied to the improvement of the infrastructure.

5. ENVIRONMENTAL SCAN (EXTERN & INTERNAL SCAN)

5.1APPLICABLE EXTERNAL FACTORS

5.1.1Political 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.