Human resource policies, health sector reform and the management of PHC services in South Africa

The establishment and strengthening of primary health care is an important component of South African health sector reform. The PHC system is by and large nurse driven. The shortage of nurses therefore negatively impacts on PHC service delivery. Nurse shortage is a multifaceted problem caused by factors such as inadequate production of nurses, migration and the impact of HIV and AIDS. While increased production and creating financial incentives to recruit nurses in the health sector is a critical part of the PHC staffing solution, interventions at the work environment level are also needed to retain nurses in the public health care system. There is clear evidence that the health sector transformation and ongoing reforms in South Africa since 1994 affect PHC nurses' work environment. This chapter attempts to unpack various HR related policies that have guided the transformation of the public sector in general, and the health sector in particular, with reference to their impact on PHC services. So far, the absence of norms and indicators to guide PHC staff production policy has helped to create a gap in the availability of nurses in relation to the growth in their need. Also, the application of transformation policy frameworks emanating from the Department of Public Service and Administration (DPSA) was not matched with the required capacity to manage the implementation of the interventions in the PHC system. Finally the absence of a coherent HR plan for the health sector has meant that interventions in this area were piece meal with at times a neglect of factors affecting nurses' motivation. These gaps in human resource management (HRM) are highlighted as areas needing urgent attention.