Developing a human resource profile for the nutrition workforce in the public health sector in the Western Cape province, South Africa
Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008.
Background: The crisis and study of health workforce has become more important in developed and developing countries. The relationship between human resource issues and health system effectiveness has been acknowledged. Human resources are seen to be one of the main constraints in achieving the millennium development goals. A number of changes have taken place within health services since 2003, including the promulgation of the new health Act 63 of 2003, restructuring processes in the Western Cape province and the development of a Comprehensive Service Plan (CSP) to implement Health Care 2010. Nationally and provincially nutrition is declared a priority, due to the documented beneficial impact of nutrition support on preventable diseases, disease of life-style, as well as the treatment of high priority disease groups, namely TB and HIV/AIDS. For appropriate planning of nutrition services, the Integrated Nutrition Programme (INP) in the Western Cape needed to review the status of the nutrition workforce in the province, towards developing a human resource plan to meet the nutrition service needs, in the provincial context, its service platforms and approved service implementation plan for public health sector. Objectives The study aimed to describe the current status of the nutrition workforce (staffing profile) in the Western Cape province in terms of staffing levels, personnel categories, location, placement, qualifications, skills, and personnel expenditure at all levels of the public health sector. Provincial maps were developed to indicate the density of personnel per category pictorially. Methods In this descriptive observational study, a targeted sampling approach was applied by developing master lists of the respective nutrition/dietetic/food service units and personnel within the geographical districts and hospitals at all levels of care. All nutrition personnel employed by the Western Cape Department of Health were included in the study. Quantitative data collection methods including coding sheets (per facility), self administered questionnaires and the official personnel database (Persal) of the Department of Health was used. Questionnaires were constructed according to the variability of services, settings, and job outputs. The respective personnel were grouped into 5 categories. Descriptive statistical methods were used to analyse data. Comparisons in terms of urban and rural distributions were also completed. Results A response rate of 86% was achieved (N = 647) with food service workers being the largest proportion of staff (N = 509), followed by dietitians (N = 64), managers (N = 31), auxiliary workers (N = 28) and administrative personnel (N= 15). Significant differences (p=0.0001- 0.05) were found amongst the respective personnel categories in terms of demographics, qualifications, training, experience, skills, competencies, time spent on the INP, and general human resource management areas. Training needs and areas of low skills were identified for the respective categories and key challenges and solutions in the nutrition workforce were highlighted. Conclusion The study indicates that the processes used to develop the workforce need to receive the same intensity as all other interventions. The results can be applied in providing evidence based information for the development of the Department of Health, Western Cape human resource plan and the integration of nutrition therein.