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WHERE HAVE ALL THE DOCTORS GONE?

WHERE HAVE ALL THE DOCTORS GONE?. AFRICA HEALTH PLACEMENTS. NO TEAM = NO GAME ANYONE WANT TO DISPUTE?. =. CONTENT. CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs

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WHERE HAVE ALL THE DOCTORS GONE?

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  1. WHERE HAVE ALL THE DOCTORS GONE? AFRICA HEALTH PLACEMENTS

  2. NO TEAM = NO GAMEANYONE WANT TO DISPUTE? =

  3. CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

  4. Doctors per 100 000 Population USA South Africa Rural Public South Africa Public Sector South Africa Public + Private SA IN CONTEXT:HOME AND AWAY (WH0, 2006)

  5. SA IN CONTEXT:QUADRUPLE BURDEN OF DISEASE

  6. POPULATION SERVED BY PUBLIC AND NUMBER OF GPs SERVING PUBLIC AND PRIVATE SECTORS PRIVATE HEALTHCARE SECTORS PUBLIC, 5,406, 27% PUBLIC, 34,611,781, 82% PRIVATE, 7,597,709, 18% PRIVATE, 14,323, 73% INEQUITIES IN HEALTHCARE DELIVERY:PUBLIC SECTOR v PRIVATE SECTOR SAHR 2004

  7. SPECIALISTS PER MILLION UNINSURED POPULATION (Urban v Rural Provinces) 339 350 300 250 208 200 150 100 60 50 27 15 7 0 North- West Northern Mpumal. Gauteng Western KZN Cape Cape INEQUITIES IN HEALTHCARE DELIVERY:RURAL v URBAN Van Rensburg & Van Rensburg, 1999

  8. 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

  9. CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

  10. A GLOBAL COMPETITION FOR RESOURCES:GLOBALISATION KILLED THE MEDICAL STAR OECD 2003

  11. A GLOBAL COMPETITION FOR RESOURCES: BRAIN DRAIN: CUMULATIVE TOLL – WE ARE LOSING Financial Mail April 2006

  12. There are more SA qualified doctors working abroad than the total number of doctors working in the public sector in SA A GLOBAL COMPETITION FOR RESOURCES: BRAIN DRAIN: CAN WE ALSO EXPORT OUR INDIGENT?

  13. NO TEAM = NO GAME:RELEGATION ZONE…

  14. PRODUCTION:A SIMPLE TREND

  15. PRODUCTION:A SIMPLE TREND • BUT: • Growing population • Increasing brain drain • Changing demographics impacting on number of “doctor hours” • Number of final graduates is declining

  16. RETENTION:ITS HOW YOU TREAT THEM, STUPID! SAMA Survey 2003

  17. CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

  18. 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

  19. 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

  20. CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

  21. POTENTIAL SOLUTIONS – PRODUCTION:IMMEDIATE AND MEDIUM-TERM SOLUTIONS MEDIUM-TERM SOLUTION: Private Sector Medical Schools IMMEDIATE SOLUTION: What do the current 8 medical universities need?

  22. CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

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

  24. BEST PRACTICE HUMAN RESOURCE MANAGEMENT MAXIMISE USE OF BURSARY SYSTEM ACTIVE RECRUITMENT POTENTIAL SOLUTIONS – RETENTION:SOLUTIONS THAT TAKE RESPONSIBILITY

  25. CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

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

  27. POTENTIAL SOLUTIONS – FOREIGN DRS:CHEAPER THE PRICE!

  28. POTENTIAL SOLUTIONS – FOREIGN DRS:A SOLUTION IS PARKING YOUR CAR POLICY Reconsider: This is working to SA and Africa’s detriment!

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

  30. CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

  31. 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).

  32. AHP PERFORMANCE IN PERSPECTIVE 8 SA Medical Schools = 1200 Graduates p.a. Remain in SA Remain in Public Service Remain in Rural Service 50% 600 Drs 25% 150 Drs 25% 35 Drs 75% 75% 50% 140 Drs in 2008

  33. WORKING AS PART OF A NETWORK:PARTNERSHIPS ARE CRITICAL NET#WORKBBDO

  34. AFRICA HEALTH PLACEMENTS:BECOMING MORE COMPETITIVE IN THE GLOBAL MARKET TIME TO PLACEMENT – FOREIGN-QUALIFIED DOCTORS 2005 1.5 Years 2008 - Average 4 - 6 Months 2008 - Australia 1 Month

  35. CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

  36. 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

  37. GREAT EXPECTATIONS:WHAT WE NEED TO DO

  38. QUESTIONS? PREPARED BY: Saul Kornik Director, AHP saulk@ahp.org.za

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