This is according to the 21st edition of the South African Health Review (SAHR) published by the Health Systems Trust (HST) on Wednesday.

Coinciding with the United Nations (UN) Universal Health Coverage (UHC) Day on December 12, the report noted the “critical importance of [human resources for health], without which UHC will remain a pipe dream”.

The Review comes amid speculation that the NHI Bill was rejected by Cabinet last week, followed by reports that the contentious piece of legislation will be discussed in a special Cabinet meeting in January.

One of the most contested aspects of South Africa’s push to UHC through the NHI is the critical shortage of health workers in the public sector, especially in rural areas, and the inequity in terms of the distribution of health personnel when compared to the private sector.

Gaps in data and staff

The authors repeatedly noted the gap in data in quantifying the gaps in the health work force but noted that there were 106 518 public-sector vacancies in 2010 for 14 clinical health professions.

“One of the critical factors impacting on South Africa’s successful journey towards universal health coverage will depend on ensuring that we have the right mix of skills and distribution of health care workers,” said Ashnie Padarath, managing editor of the Review.

The shortage is even more pronounced in rural areas: despite the fact that almost half of the population lives in these areas, only 12 percent of doctors and 19 percent of nurses work there.

The report noted that R12-billion is spent every year on health sciences education but that this “economic investment” with “recurring benefits” often falls short in retaining health workers in undeserved and rural areas.

Need highest in rural areas

About 1 200 medical students graduate in the country annually, yet only around 35 end up working in rural areas long-term.

While community service – the period when health workers are placed in public health facilities on completion of their studies – has brought skills to these communities, strategies are needed to retain them long term.

Research has shown that doctors originating from rural areas are significantly more likely to return to work in those areas and the Review highlighted a KZN project providing financial and educational support for rural learners to become health workers.

“Extension of the model may increase the number of healthcare workers in rural areas, which is promising given that staffing rural areas is likely to be a major challenge in the successful rollout of the National Health Insurance system,” noted the authors.

UHC through NHI

The global UN-backed goal of realising UHC is defined by the World Health Organisation as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship”.

South Africa’s chosen route to achieving UHC is the much-debated NHI, which is based on a central fund which will finance a basic basket of services every South African will be entitled to and aims to move away from the current two-tiered system.

On Monday health minister Dr Aaron Motsoaledi announced the creation of more than 5 300 health worker posts across the country from January 2019, as a first step to alleviate the human resources shortage in preparation for the NHI.

Said HST’s chief executive officer Dr Themba Moeti: “This year’s edition of the SAHR is particularly timely, with its focus on human resources for heath and related innovative and practical solutions to support sustainable progress towards achieving UHC; essential for future health service success.”