Browsing by Author "Ranchod, Shivani"

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    Human resources for health planning and national health insurance : the urgency and the opportunity
    (Health Systems Trust, 2018) Smith, Anja; Ranchod, Shivani; Strugnell, Dave; Wishnia, Jodi
    The implementation of National Health Insurance (NHI) amplifies the urgent need for coordinated, comprehensive health workforce planning in South Africa. Planning for and estimating the cost of adequate human resources for health (HRH) is of paramount importance to a well-functioning health system. Planning is also a central requirement for a strategic purchaser of health services tasked with matching healthcare needs with the supply of services. The NHI is likely to alter health staffing requirements in South Africa as it strives to improve quality of and equitable access to health care. Increased healthseeking behaviour anticipated under NHI implies increased need for all cadres of healthcare workers, particularly specialists and general practitioners (GPs), who are underrepresented in the public sector. The creation of the NHI Fund also provides the opportunity for much-needed HRH planning on a more systematic and regular basis. At present there is no ongoing process for HRH planning and no single, high-quality, integrated data source in South Africa to enable such planning. A review of the available data, together with the limitations of these data, is presented. There are no publicly available, audited and regularly updated statistics on the number and mix of health workers available and required for South Africa’s population. This chapter considers both global best practice in health workforce planning and the South African context of critical shortages in order to recommend a way forward. The creation of a timely, accurate and integrated repository of human resources data is an essential first step. We recommend the creation of a multi-stakeholder structure tasked with the development of integrated plans that consider the health system as a whole, based on models that account for both supply-side dynamics and the need for services, and that explicitly model the interactions between cadres of healthcare workers.
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    South Africa’s hospital sector : old divisions and new developments
    (Health Systems Trust, 2017) Ranchod, Shivani; Adams, Cheryl; Burger, Ronelle; Carvounes, Angeliki; Dreyer, Kathryn; Smith, Anja; Stewart, Jacqui; Van Biljon, Chloe
    The hospital sector in South Africa mirrors deep inequalities in the country as a whole. The private, for-profit hospital sector is well resourced and caters to a population that tends to be wealthier, urban and more likely to be formally employed. The public-hospital sector, catering to the majority of South Africans, faces lower human-resourcing ratios, financial constraints and ageing infrastructure. This chapter contextualises the development of the two sectors, describes the current divide, and considers the implications in terms of equity, access and quality of care. A unique dataset of quality-accreditation-survey scores was used, which allowed for analysis of the two sectors according to a common yardstick. These data reflect a wide array of structure- and process-related quality indicators; in addition, the patient perspective reflected in data from the General Household Survey was used to illustrate the quality differential. The research provides evidence of the polarisation between public and private facilities: private facilities consistently scored above public facilities across a range of accreditation categories, and there was far greater variability in the scores achieved by public facilities. The same polarised relationship was found to hold across key sub-components of the scores, such as management and leadership of hospitals in the two sectors. We conclude that there is a need for the measurement of health outcomes across the system. Policy attention is required in terms of accountability and quality improvement. A focus on improving value in the system will, by necessity, have to engage with the discrepancies between the sectors.