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National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 3 : Problem Statement

3.3 Structual problems in the health system

3.3.3 Health workforce challenges


58. The inequities and poor quality in the health system are exacerbated by a skewed distribution of key health professionals between the public and private sectors. The main contributor to this inequity is the creation of a two-tier healthcare system where the affluent pool their healthcare funds separately from the poor. The shortage of key health professionals is being experienced in the face of the growth of the population that is dependent on public healthcare services, and the increasing burden of disease among the population, and unpredictable inward migration patterns. This has placed an extraordinary strain on public sector health services, and on the staff who work in public sector facilities and has contributed to the very poor health outcomes of South Africans, particularly for the lowest income populations and households.


59. In addition to the mismatch between the public and private health sectors relative to the size of the population served, there is a mismatch between urban and rural areas; as well as inefficiencies in the use of available human resources34. Most of the providers work in urban areas while there is a serious shortage in the rural areas. This disproportionate distribution is also prevalent across the provinces, with the Western Cape and Gauteng having higher doctor-to-population ratios when compared with the rest of the provinces. The mal-distribution pattern of health professionals between rural and urban areas, and the public and private sectors has contributed to transforming health into a commodity rather than a social investment or a human right.35


60. The changing population and health profiles in South Africa occur within financial resource constraints and in an environment in which there is mal-distribution of the health workforce36 .The impact of the decline in real per capita spending is possibly best illustrated through looking at staffing levels in the public health sector.


61. Other factors that have contributed to human resources shortages and attrition especially relates to job design, performance management systems, remuneration policies, employment relationships, in hospitable physical work environment, shortages of equipment and other tools of trade, workplace cultures and human resource practices, facility workforce planning and career-pathing. These factors have affected the motivation and the ability of the healthcare sector to recruit and retain the health workforce. The education and training of health professionals has lagged behind and the public sector continues to experience insufficient planning and budgeting for clinical posts, resulting in high attrition rates.