APPENDICIES
6.2. Themes
6.2.2. Human Resource Challenges
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P7: There are no resources and equipment. We are struggling, so maybe clients come
with an ear problem. There are no instruments or equipment to examine the patient with. You have to go to another room and wait for the sister who is maybe using that ENT set.
Two participants specifically cited the addition of park homes at two of the facilities as the only type of improvement that has happened at the PHC level since the piloting of NHI began:
P4: They have already put up the homes and they are still busy with them but it shows
that at least they are doing something because, the thing we are complaining. For us, the Re-Engineering was wonderful. We were short of consultation rooms, the
structure was too small so because now they have put up the park homes.
P6: With regard to NHI we have not yet started___. But we are busy so far… they have started with the building.
What was evident from all the participants, was the fact that numerous challenges still exist within the current health care system and these need to be addressed if the hope of NHI is to materialise.
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are not replaced timeously in health facilities. This is in addition to the pervasive
international migration of health care professionals impacting extensively on the national skills deficit which continues to exist as noted above in chapter 2. The research participants captured these concerns aptly and posed vexing questions about human resource management and the consequent impact on their essential service delivery:
P4: Because of shortage of staff, you will be saying “Sister whoever, can you do this
for me?” But she has to do___, she will be doing a managerial job and then she has to do clinical job.
The above response succinctly summarises how many of the nurses working in public health do two jobs while only being remunerated for one. There was a dual expectation from the nurses to perform both clinical and administrative tasks. According to one participant, some nurses were asked to volunteer to do extra duties without expecting to be remunerated or promoted. This self-initiation was an alternative to addressing unfilled posts and that of staff leaving the service:
P5: Another problem is that if for example staff leave, they are not replaced
immediately, where does their salary go? Why are they taking our time? Now we have five, my colleague left, because she went to the municipality but she’s never been replaced…Where did the money go? Why can’t they appoint a permanent person immediately?
P6: For example, for now there have been nurses who went away, so the department has not yet hired or advertised the post, you can feel for us.
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P7: If you complain to the management they don’t fill up posts. They wait for the
financial year to end and it’s going to take a lot of time because its procedure. They have to advertise, call people for interviews, short listing and so forth. Maybe the advertisement is in April but you find that those people are going to be hired in April but come to the clinics in June.
P6: We are overworked but there is nothing we can do for now, there is a shortage of
staff, only two sisters. There are more tasks but fewer people. I am supposed to see 35 patients as per my guideline, seeing 70 patients is too exhausting. After 12, your mind is already tired.
The four participants above succinctly highlighted the many questions staff at PHC facilities have with regard to staffing issues. This poses the question of how effective is the communication at both the facility and district level, when many of the staff feel that their legitimate queries are not resolved.
6.2.2.1. Effectiveness of Communication
Effective communication is a vital tool an OD practitioner utilises extensively during implementation of change interventions. It impacts on the effectiveness and sustainability of any change programme when members of the organisation have a distinct understanding of the desired change. Earlier, it was emphasised by Participant 7 that she possessed little knowledge about the major changes occurring within the health system. It became evident that although some (n = 2) participants expressed their support for the stipulated changes, a vast majority (n = 6) felt excluded during the process. They cited being undervalued and
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ultimately powerless at the system failing them and the patients. This powerlessness was also illustrated by the narrative of Participant 2 previously, when she reported that she could not refuse PC101 training. Participant 1 indicated difficulties on procedural communication:
P1: Did you follow those patients? Did you find out what happened to those patients?
That’s what they say to us during presentations but they didn’t tell us that earlier!”
This respondent appeared to be frustrated at the system the DoH employed to rate a nurse’s performance. According to the participant, they were never afforded training on filling in the performance management development system (PMDS) form:
P7: With those PMDS it’s so unfair because you will work. Then when it comes to the
presentation, they will introduce new thing that we were not aware of when writing those PMDS. They will only tell you during the presentation that you were supposed to do 1, 2, and 3.
The PMDS system and the applicability of the form in light of the changes in the system is questionable in terms of its adaptability and how it engages with their present job
environment. The current system still favours quantity over quality and this perpetuates the notion of pushing the queues and getting statistics:
P4: I am supposed to be on duty, and then I have to do 1, 2, and 3. It’s month end, the statistics are due and we need to do that.
Quantifications, as opposed to how well the nurse assisted the patient were reported by Participant 1 as an issue in staffing: