oa South African Health Review - Human resources for health and universal health coverage : progress, complexities and contestations - review

Volume 2018 Number 1
  • ISSN : 1025-1715



Human resources for health (HRH) are critical to the achievement of universal health coverage reforms. Drawing on theories of the health labour market, this chapter highlights the progress, complexities and contestations pertaining to HRH since publication of the last South African Health Review. Positive HRH developments during the review period include: government’s commitment to developing HRH norms and standards; confirmation of a relatively strong health professional regulatory framework that provides a foundation for reforms; the publication of a major study on health professions education; and embryonic initiatives to develop HRH strategic plans linked to universal health coverage. Major gaps and weaknesses in the current HRH foundation must be addressed to ensure a high-quality health system and the success of the proposed national health insurance (NHI) reforms. These weaknesses include: insufficient stewardship of HRH planning across the entire healthcare system; lack of a national integrated HRH information system, and inadequate information on overall HRH supply to address historical inequities between urban and rural areas and the public and private health sectors; gaps, and at times failures, in HRH governance; fragmentation, weak coordination and suboptimal governance of health sciences education; and poor and ineffective operational management across all types of health facilities and provincial health departments, with rural provinces worse off than their urban counterparts. Key recommendations include enhancing HRH technical capacity and expertise in the National Department of Health to provide strategic leadership and support for the entire health system; recruitment of public servants with the right skills, competencies, ethos and values; and the equitable allocation of resources to rural and/or underserved areas.

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