oa South African Health Review - Human resource requirements for National Health Insurance : perspectives on a national health insurance



In 2007, at its 52nd Conference in Polokwane, the African National Congress called for the implementation of a National Health Insurance (NHI) scheme. The proposed NHI scheme will potentially significantly increase funds available for health and restructure health service delivery. However, the success or failure of a NHI scheme will rely on the availability, skills and motivation of health workers.

This chapter will summarise key human resource (HR) challenges in South Africa and sketch important requirements to support the implementation of a NHI-funded health system. Transformation of the health system has been hampered by inadequate numbers and inequitable distribution of health workers between private and public sectors and urban and rural areas, lack of appropriate skills throughout the system, and poor planning and management. Clinic based services are limited in their ability to reach community level and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. There are a large number of community health workers in the country, yet they remain disorganised and peripheral to the public health system and the mid-level worker category has not been fully explored. Finally, there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas.
Using available evidence and information from interviews conducted with a number of key informants, the authors make recommendations on HR requirements for implementation of an effective and equitable health system funded by a NHI, including skills mix and projected numbers of health workers, and propose ways to improve the deficient HR situation.


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