The RHAP welcomes the Health Minister’s statement on staffing moratoria and calls for the protection of critical health posts in times of austerity
9 February 2016
The RHAP welcomes the Minister’s statement to the press dated 8 February in which he responds to allegations of “frozen posts” in the health system. In his response the Minister wishes to “put it on record that there are no medical posts frozen in this country”.
RHAP has previously called for national guidance on how provincial departments of health and provincial treasuries protect critical posts in times of austerity. This followed an increase in the number of reports we received from the coalface of posts going unfilled despite the availability of health care professionals. We then undertook to investigate the situation in several provinces to understand the causes and consequences of what appeared to be moratoria on the filling of vacant posts.
We found that moratoria on filling posts across the spectrum of health care professionals were being implemented in one of two ways. The first was through official moratoria where instructions and circulars were sent to district and facility managers limiting or blocking entirely their ability to fill posts.
In other instances we found that while an official moratoria was not in place the appointment of staff to vacant posts was centralised to the province and in some instances even Heads of Department, Treasuries and Premiers. In these instances appointments were often not signed off or delayed, to the detriment of understaffed facilities and their patients.
Provinces also resort to the abolishment of posts to bring down the vacancy rates.
In our assessment of the situation we found that the cause of these moratoria was primarily budgetary. Containing costs within the human resource establishment was a component of controlling expenditure in a context of flat-lining budgets
These austerity measures, as they have been implemented to date, can lead to catastrophic consequences for health care, particularly for rural health settings. Consequences include diminished capacity to deliver services; poor supervision of existing staff; weakened support processes (e.g. procurement); additional strain being put on already overburdened staff; and consequently, overburdened staff leaving the public service deepening the crisis.
While the RHAP acknowledges that we are entering a time where the budget is severely constrained and that not every vacant post can be filled, critical posts must be protected at all times.
RHAP therefore calls upon the National Department and Treasury to provide guidance through policy on how provinces are expected to protect critical posts at times of austerity.
The RHAP believes that the consequences on patient care should be the determining factor on deciding whether post A in facility B is critical under the given circumstances. A critical post therefore does not only include doctor and nurse posts but also other health professionals and support staff. A hospital without cleaners cannot deliver a safe service whilst the current tragic cuts in rehab posts can lead to preventable permanent disability of the most vulnerable children in our country.
For a full set of recommendations access our discussion document here. These were developed during a consultative workshop with civil society partners as well as stakeholders from the National Treasury and provincial and district health representatives from a few provinces on 26 November 2015.
We look forward to a Budget Speech by the Minister of Finance on 24 February 2016 that acknowledges the need to identify and protect critical posts in health and other social sectors despite today’s budget constraints.
Programme Manager: Rural-Proofing, Rural Health Advocacy Project
Tel: +27 11 880 0995 ext 111
Fax: +27 11 339 4311
Cell: + 27 72 249 3873
 http://www.rhap.org.za/kzn-circular-october-2015-motatorium-in-filling-of-posts/ ; http://www.rhap.org.za/memo-by-north-west-provincial-government_staffing-moratoria/ ; http://www.rhap.org.za/eastern-cape-doh-staffing-moratoria_september-2015/ ;