Development of the North West Critical Health Posts Tool

Development of the North West Critical Health Posts Tool

After years of research and advocacy, The Rural Health Advocacy Project announces the next step in our Critical Health Posts work – a pilot project in North West Province that places not only clinical consequences at the centre of decision-making but also rurality factors and vulnerable patient groups. A project that promotes equity and access principles in line with the vision of NHI of Health for ALL, based on need, and regardless of ability to pay and geographical location.


In South Africa, provincial health departments are increasingly faced with reduced health budgets and hiring moratoria in the context of unyielding patient need. Health decision makers are given the unenviable task of allocating scarce resources across equally needy areas, balancing patient and health system needs across districts and provinces with vast geographic, infrastructure and resource differences. Though the South African Promotion of Administration Justice Act (PAJA) provides that administrative action such as budget cuts should be reasonable, i.e. equitable, evidence-based, rational and proportional, the National Department of Health (NDoH) and the National Treasury provided limited guidance to health decision-makers on how to implement the Act in their setting. In the absence of a standardized, evidence-based approach that health planners can apply, austerity measures are often implemented in a way that disproportionately disadvantages the most rural and underserved patients.


Following a research paper on the causes and consequences of budget austerity on the filling of health posts, the Rural Health Advocacy Project (RHAP) developed guidelines in 2015 for protecting critical health posts in times of austerity. These guidelines were reviewed and endorsed by the South African National Treasury, and in 2016, the National Department of Health (NDoH) convened two rural Recruitment and Retention (R&R) partner workshops to discuss, in part, how the guidelines could be applied in practice. At the invitation of the NDoH, the North West (NW) province agreed to participate with the non-governmental organisation (NGO) partners Africa Health Placements (AHP) and the Rural Health Advocacy Project (RHAP) in a pilot project to operationalize the guidelines.

North West Province Recruitment Prioritisation Tool

The North West Province Recruitment Prioritisation Tool enables health planners to apply a rational, systematic and equitable approach in determining which health posts to prioritise in the context of resource constraints. It includes decision-making matrixes for prioritizing of posts for the Districts and the Provincial Office, based on three categories:

  • Clinical Consequences
  • Rural Location/ No Alternative Service
  • Vulnerable Patient Group

The Tool was presented to, reviewed and adopted by the NW DoH and Treasury in February 2017, and again in August 2017 it received full support at a Provincial Senior Management Team meeting. A pilot is now taking off in North West Province.

The strategies, tools and lessons learned from the NW are intended to be used to further development of national and provincial policies and strategies to ensuring the fair and equitable application of austerity measures on health posts.

Access the documents:

– Conference Poster: PosterPresentation RHAP RHC2017

– National Guidelines with broad principles for priority-setting in filling of health posts 

– Provincial guidelines for implementation of the Tool

– For a free copy of the Tool, contact:

Research report on causes and consequences of budget austerity on filling of health posts

– PHASA Publication