As a result, a second wave of health reforms followed in aroundwith the ANC National Congress Polokwane serving as a turning point.
Similarly, the two main forms of with in-country migration of health professionals, that is, rural to urban and public to private, are enduring problems in that these workforce flows constantly cause and aggravate existing imbalances and inequalities both in the distribution of HRH and also in access to care; they thus weaken both public and rural health services, while also negatively affecting the effectiveness of services [ 17 ].
This trend is attributable to the expansion of the private hospital industry during this time, the increased employment of nurses in the private sector, and the accelerated production of nurses by private nurse-education institutions for deployment and retention in private facilities [ 43 ].
The distribution and retention strategy that has had the strongest impact on countering HRH shortages and on the maldistribution of HRH in the South African public health sector has probably been the introduction of compulsory CS: this was first introduced in for doctors and since then systematically expanded to cover all graduating health professionals, with the last of these being the nurses in Strategies for promoting efficiency, access, redistribution and retention Sincethe government has launched various HRH production, distribution and retention strategies in an effort to better balance existing public-private and urban -rural disparities and to strengthen both its public and rural health services.
The horrible conditions in these camps caused the death of 4 women, 22 children under sixteen and 1 men, mainly those too old to be on commando. Table 2 Provincial disparity ranges only extremes of selected health professionals in the public sector Professional category Provincial disparity range best and worst ratios Medical practitioners Western Cape versus Limpopo Registered nurses Free State versus Gauteng Dentists Western Cape versus 1: 42 Limpopo Pharmacists Western Cape versus Limpopo Physiotherapists Western Cape versus Limpopo Occupational therapists Western Cape versus North West Dental therapists Mpumalanga versus Western Cape Psychologists Open in a separate window The post reforms have thus largely failed to effect sufficient change in HRH distribution and in access to health care.
However, the interests of a strong free-market conglomerate white government, the health professions, and big business always successfully countered such ideals [ 25 ].
The negative effects of CS as a measure for distributing and retaining HRH have also been recorded, such as that few CS professionals have stayed on in public service and that the system serves as a strong push factor for young professionals to emigrate [ 15515658 ].
These figures indicate the magnitude of the scourge and of the immense backlogs in coverage that have over many years built up in the numbers of people in need of ART.
Where such plans did and do exist, for example, the consecutive HRH plans of [ 33 ] and [ 34 ], their systematic implementation for various reasons either lags behind or fails [ 16 ]. Nondyero Shabalala runs Incredible Tours and Travel, a growing South African tourism agency which she established in