An assessment of South African policy and strategic framework for the development of a sufficient, equitably distributed and well-performing health workforce for the implementation of the National Health Insurance

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Background. South Africa (SA), like the rest of the global village, is faced with the need to address health worker shortages, improve the performance of health workers and ensure an equitable distribution of health workers in all settings. This requires leadership, governance and stewardship acumen to put in place policies, practices and resources that are essential to recruit and retain human resources for health. Objective. To determine whether SA possesses a strong and competent policy and strategic framework that would guide the development of a sufficient, fairly distributed and well-performing health workforce. Methods. A cross-sectional descriptive quantitative study was undertaken using pretested anonymous questionnaires to solicit responses about the ability, strategies and policies needed to address health workforce challenges. The study was undertaken in SA with decision- makers and/or those who contribute to health sector reforms in SA in the realisation of the National Health Insurance (NHI). They were individuals and stakeholders who interact with and/or are in the employment of statutory health councils, regulatory bodies, medical aid administrators, medical schemes, voluntary bodies/organisations and healthcare workers who are registered with the SA Pharmacy Council, Health Professions Council of SA and SA Nursing Council. Results. The findings indicate that the current policies and frameworks to address health worker shortage, their performance improvement and the rural-urban disparities in the distribution of health workers are not sufficient to address the current challenges. The study found that specific efforts to address policy shortcomings need to be embarked upon. Conclusion. The current policies and strategies are not sufficient to address health workforce challenges to improve performance, maintain appropriate skills, improve working conditions and ensure an equitable distribution of health workers to address the healthcare needs of SA. Commitment to the NHI should be matched with the capacity to deliver health services, which is highly dependent on the availability of a qualified and motivated workforce. The capacity to deliver services aligned to the objectives of the NHI will require that policy-makers consider interventions aimed at addressing challenges related to recruitment and limitation of career opportunities. Performance and productivity challenges may best be addressed by meaningful engagements and collaboration with the private for-profit, voluntary and independent sectors.