Re-Envisioning Global Health Competencies for the African Region Aligned with Local Health Needs and Resources.

Background: While many Global Health programs aim to address health inequalities within and between HICs and low- and middle-income countries (LMICs) there is a need to establish new Global Health academic programs within the growing trend towards 'internationalization of higher education'. Objective: This study was undertaken to re-envision Global Health competencies for the African region context with respect to the local health needs and availability of resources. Methods: This study was undertaken over a period of four years from 2017 till 2020. A three-pronged strategy was undertaken to scan, scope, distil and develop a set of Global Health domains and competencies for the African region. Strategy 1 encompassed an environmental scan of Global Health competencies (2017-2019), and a literature review (2017-2020); strategy 2 comprised a scoping of education programs in Global Health (2018-2019); and strategy 3 involved an interest-group discussion in a face-to-face conference. Findings: Seven core and four cross-cutting global health competency statements were developed for the African region. The core competency statements included following domains: global health systems and international relations; global evidence ecosystem; role of international organizations; universal health issues; intellectual property rights; responses to issues affecting different at-risk groups; local, national, and international policy and economic context affecting global health. The four cross-cutting competency statements included following domains: digital and academic literacies; quantitative and qualitative research; policy and funding allocation resources; ethical conduct of global health practice and research global health. Conclusion: There is a need to enable higher education institutions (HEIs) from the Global South to offer global health qualifications with a set of competencies that better approximate solutions to contextualised problems - not only to students from the Global South but also from the Global North. The global health competencies developed in this research study will enable African HEIs to offer global health education in a more pragmatic manner.

Temporal Trends in the South African Diagnostic Radiology Workforce (2002-2019).

Background To facilitate imaging resource planning and address key health targets of the United Nations (UN) 2030 Sustainable Development Goals, accurate data are required on imaging personnel at the country level. Such data are currently limited. Objectives This study aims to analyze trends in the number, geographical distribution, and demographics of South African (SA) diagnostic imaging personnel between 2002 and 2019. Method A retrospective analysis of the Health Professions Council of South Africa (HPCSA) database of imaging personnel from 2002 to 2019 was done. The total number of personnel and personnel per million people were calculated for the country and for each professional group (radiologist, diagnostic radiographer, and sonographer) by calendar year, province, and demographic profile. Population data were provided by Statistics SA. Results The total imaging personnel, number per million people, and national population increased by 283% (3,095 versus 8,753), 119% (68 versus 149/106), and 29% (45.45 versus 58.77/106), respectively. Diagnostic radiographers constituted more than 80% of the workforce throughout the review period, increasing by 185% (2,540 versus 7,242). Sonographers, the smallest cohort, recorded the highest (49 versus 503; 906%) and radiologists (506 versus 1,007; 99%) the lowest proportional growth. Although radiologists showed persistent male predominance, the male proportion decreased from 82% to 69%, while that of females increased from 18% to 31%. The average annual percentage increase in female radiologists (14%) was more than three times that of males (4%). Diagnostic radiographers showed female predominance, but the proportion decreased from 90% to 83%, while that of males increased from 10% to 17%. Sonographers showed overwhelming female predominance (94% versus 92%). The average annual percentage increase in male diagnostic radiographers (21%) was more than double that of females (9%). In 2002, 48% (n = 1,475) of imaging personnel identified as White, and 15% (n = 467) identified as Black African. By 2019, those identifying as White and Black African were 36% (n = 3,122) and 35% (n = 3,045), respectively. The Western Cape Province (WCP) maintained the highest overall number of imaging personnel per million people (165 versus 233/106) and Limpopo the lowest (12 versus 54/106). However, Limpopo recorded the highest proportional growth in imaging personnel/106 people (368%) and the WCP the lowest (41%). The differential between the best- and least-resourced provinces thus decreased from 14:1 in 2002 to 4:1 in 2019. Conclusion In the review period, the SA imaging workforce has shown substantial expansion and transformation and has assumed a more equitable distribution.

Outcomes of hospitalised patients with hyperkalaemia at a South African tertiary healthcare centre.

Background: Hyperkalaemia is a common electrolyte disorder in hospitalised patients. There is a lack of data from Africa on the prevalence, causes and outcomes of patients with hyperkalaemia. We aimed to identify the frequency of hyperkalaemia in hospitalised adults, and to identify any risk factors for in-hospital death. Methods: We conducted a retrospective cohort study of 1921 adult patients admitted to hospital with hyperkalaemia (potassium concentration ([K]) ≥ 5·5 mmol/L) over a one-year period during 2019. Multivariable logistic regression was performed to identify predictors of in-hospital mortality and multilinear regression was used to identify associations with the [K]. Findings: We found an incidence rate of 3·7 cases per 100 patient-years. Nearly a third died during hospitalisation. Acute kidney injury (AKI) was common in patients who died (69·2% vs. 41·3%, P < 0·01). Age (odds ratio (OR) 1·02, 95% CI 1·01-1·03), [K] (OR 1·38, 95% CI 1·12-1·71), AKI (OR 3·13, 95% CI 2·19-4·47) and acute therapy (OR 1·93, 95% CI 1·40-2·66) were predictors of in-hospital death. AKI (r = 0·29, P < 0·01) and chronic kidney disease (r = 0·31, P < 0·01) were associated with the [K]. Fourteen percent of patients with hyperkalaemia were HIV positive with no difference in in-hospital death (P = 0·75). Interpretation: This is the largest study reporting on the epidemiology of hyperkalaemia in hospitalised adults from Africa. Hyperkalaemia in association with AKI was a strong predictor of in-hospital death. Late presentation to hospital may be a major factor contributing to poor outcomes. Funding: Self-funded.

Hypoglycaemia due to insulin therapy for the management of hyperkalaemia in hospitalised adults: A scoping review.

INTRODUCTION: Hyperkalaemia is a very common electrolyte disorder encountered in hospitalised patients. Although hypoglycaemia is a frequent complication of insulin therapy, it is often under-appreciated. We conducted a scoping review of this important complication, and of other adverse effects, of the treatment of hyperkalaemia in hospitalised adults to map existing research on this topic and to identify any knowledge gaps. MATERIALS AND METHODS: We followed the PRISMA-ScR guidelines. Studies were eligible for inclusion if they reported on any adverse effects in hospitalised patients ≥18-years-old, with hyperkalaemia receiving treatment that included insulin. All eligible research from 1980 to 12 October 2021 were included. We searched Medline (PubMed), Embase (Ovid), the Cochrane Library, CINHAL, Africa-Wide Information, Web of Science Core Collection, LILACS and Epistemonikos. The protocol was prospectively registered with the Open Science Framework (https://osf.io/x8cs9). RESULTS: Sixty-two articles were included. The prevalence of hypoglycaemia by any definition was 17.2% (95% CI 16.6-17.8%). The median timing of hypoglycaemia was 124 minutes after insulin administration (IQR 102-168 minutes). There were no differences in the prevalence of hypoglycaemia when comparing insulin dose (<10 units vs. ≥10 units), rate of insulin administration (continuous vs. bolus), type of insulin (regular vs. short-acting) or timing of insulin administration relative to dextrose. However, lower insulin doses were associated with a reduced prevalence of severe hypoglycaemia (3.5% vs. 5.9%, P = 0.02). There was no difference regarding prevalence of hypoglycaemia by dextrose dose (≤25 g vs. >25 g); however, prevalence was lower when dextrose was administered as a continuous infusion compared with bolus administration (3.3% vs. 19.5%, P = 0.02). The most common predictor of hypoglycaemia was the pre-treatment serum glucose concentration (n = 13 studies), which ranged from < 5.6-7.8 mmol/L. CONCLUSION: This is the first comprehensive review of the adverse effects following insulin therapy for hyperkalaemia. Hypoglycaemia remains a common adverse effect in hospitalised adults. Future randomised trials should focus on identifying the optimal regimen of insulin therapy to mitigate the risk of hypoglycaemia.

Estimating the emergency care workforce in South Africa.

BACKGROUND: Emergency care is viewed as a fundamental human right in South Africa's constitution. In the public sector, all emergency medical services (EMS) come under the Directorate: Emergency Medical Services and Disaster Medicine at the National Department of Health (NDoH), which provides regulation, policy and oversight guidance to provincial structures. AIM: The aim of the study is to understand the supply and status of human resources for EMS in South Africa. SETTING: This research was undertaken for South Africa using the Health Professions Council of South Africa (HPCSA) database from 2002 to 2019. METHODS: A retrospective record-based review of the HPCSA database was undertaken to estimate the current registered and future need for emergency care personnel forecasted up to 2030. RESULTS: There are 76% Basic Ambulance Assistants registered with HPCSA. An additional 96 000 personnel will be required in 2030 to maintain the current ratio of 95.9 registered emergency care personnel per 100 000 population. The profile of an emergency care personnel employed in South Africa is likely to be a black male in the age group of 30-39-years, residing in one of the economically better-resourced provinces. CONCLUSION: It is time that the current educational framework is revised. Policy interventions must be undertaken to avoid future shortages of the trained emergency care personnel within South Africa.

Estimating the Specialist Surgical Workforce Density in South Africa.

Background: South Africa is an upper middle-income country with inequitable access to healthcare. There is a maldistribution of doctors between the private and public sectors, the latter which serves 86% of the population but has less than half of the human resources. Objective: The objective of this study was to estimate the specialist surgical workforce density in South Africa. Methods: This was a retrospective record-based review of the specialist surgical workforce in South Africa as defined by registration with the Health Professionals Council of South Africa for three cadres: 1) surgeons, and 2) anaesthesiologists, and 3) obstetrician/gynaecologists (OBGYN). Findings: The specialist surgical workforce in South Africa doubled from 2004 (N = 2956) to 2019 (N = 6144). As of December 2019, there were 3096 surgeons (50.4%), 1268 (20.6%) OBGYN, and 1780 (29.0%) anaesthesiologists. The specialist surgical workforce density in 2019 was 10.5 per 100,000 population which ranged from 1.8 in Limpopo and 22.8 per 100,000 in Western Cape province. The proportion of females and those classified other than white increased between 2004-2019. Conclusion: South Africa falls short of the minimum specialist workforce density of 20 per 100,000 to provide adequate essential and emergency surgical care. In order to address the current and future burden of disease treatable by surgical care, South Africa needs a robust surgical healthcare system with adequate human resources, to translate healthcare services into improved health outcomes.

Trends in the nephrologist workforce in South Africa (2002-2017) and forecasting for 2030.

BACKGROUND: The growing global health burden of kidney disease is substantial and the nephrology workforce is critical to managing it. There are concerns that the nephrology workforce appears to be shrinking in many countries. This study analyses trends in South Africa for the period 2002-2017, describes current training capacity and uses this as a basis for forecasting the nephrology workforce for 2030. METHODS: Data on registered nephrologists for the period 2002 to 2017 was obtained from the Health Professions Council of South Africa and the Colleges of Medicine of South Africa. Training capacity was assessed using data on government-funded posts for nephrologists and nephrology trainees, as well as training post numbers (the latter reflecting potential training capacity). Based on the trends, the gap in the supply of nephrologists was forecast for 2030 based on three targets: reducing the inequalities in provincial nephrologist densities, reducing the gap between public and private sector nephrologist densities, and international benchmarking using the Global Kidney Health Atlas and British Renal Society recommendations. RESULTS: The number of nephrologists increased from 53 to 141 (paediatric nephrologists increased from 9 to 22) over the period 2002-2017. The density in 2017 was 2.5 nephrologists per million population (pmp). In 2002, the median age of nephrologists was 46 years (interquartile range (IQR) 39-56 years) and in 2017 the median age was 48 years (IQR 41-56 years). The number of female nephrologists increased from 4 to 43 and the number of Black nephrologists increased from 3 to 24. There have been no nephrologists practising in the North West and Mpumalanga provinces and only one each in Limpopo and the Northern Cape. The current rate of production of nephrologists is eight per year. At this rate, and considering estimates of nephrologists exiting the workforce, there will be 2.6 nephrologists pmp in 2030. There are 17 government-funded nephrology trainee posts while the potential number based on the prescribed trainer-trainee ratio is 72. To increase the nephrologist density of all provinces to at least the level of KwaZulu-Natal (2.8 pmp), which has a density closest to the country average, a projected 72 additional nephrologists (six per year) would be needed by 2030. Benchmarking against the 25th centile (5.1 pmp) of upper-middle-income countries (UMICs) reported in the Global Kidney Health Atlas would require the training of an additional eight nephrologists per year. CONCLUSIONS: South Africa has insufficient nephrologists, especially in the public sector and in certain provinces. A substantial increase in the production of new nephrologists is required. This requires an increase in funded training posts and posts for qualified nephrologists in the public sector. This study has estimated the numbers and distribution of nephrologists needed to address provincial inequalities and achieve realistic nephrologist density targets.

Impacts of Tooth Loss on OHRQoL in an Adult Population in Cape Town, South Africa.

(1) Background: Tooth loss is an important component of the global burden of oral disease, greatly reducing the quality of life of those affected. Tooth loss can also affect diet and subsequent incidences of lifestyle diseases, such as hypertension and metabolic syndromes. This study aimed to evaluate the oral health-related quality of life (OHRQoL) score using the oral impacts on daily performance (OIDP) index in relation to tooth loss patterns among adults. (2) Methods: From 2014 to 2016, a cross-sectional study was conducted on adults living in Bellville South, Cape Town, South Africa. The OHRQoL measure was used to evaluate the impact of tooth loss. (3) Results: A total of 1615 participants were included, and 143 (8.85%) had at least one impact (OIDP > 0). Males were less likely to experience at least one impact compared to the females, OR=0.6, 95% C.I.: 0.385 to 0.942, p = 0.026. Those participants who did not seek dental help due to financial constraints were 6.54 (4.49 to 9.54) times more likely to experience at least one impact, p < 0.001. (4) Conclusions: Tooth loss did not impact the OHRQoL of these subjects. There was no difference in the reported odds for participants experiencing at least one oral impact with the loss of their four anterior teeth, the loss of their posterior occlusal pairs, or the loss of their other teeth.

Forecasting for the need of dentists and specialists in South Africa until 2030.

To manage the increasing burden of dental diseases, a robust health system is essential. In order to ensure the oral health system operates at an optimal level going into the future, a forecast of the national shortfall of dentists and dental specialists in South Africa (SA) was undertaken. There is currently a shortage of dentists and specialists in SA and given the huge burden of dental diseases, there is a dire need to increase the number of these health care workers. The aim was to determine the projected shortfall of dentists and specialists in each of the nine provinces in SA. The projected shortfall was calculated based on the SA Disability-Adjusted Life Years (DALYs) for each province. The estimate for the evaluation of the Global Burden of Disease (GBD) for SA was obtained from the Institute of Health Metrics and Evaluation (IHME) Global Burden of Disease website. For each province, age standardized DALYs were calculated with mid-year population estimates obtained from Statistics SA 2018. In order to reduce the existing human resources for health (HRH) inequity among the provinces of SA, three scenarios were created focussing on attaining horizontal equity. The best-case scenario estimates a shortfall of 430, 1252 and 1885 dentists and specialists in 2018, 2024 and 2030 respectively. In an optimistic scenario, the national shortfall was calculated at 733, 1540 and 2158 dentists and specialists for the years 2018, 2024 and 2030 respectively. In an aspirational scenario, shortfalls of 853 (2018), 1655 (2024) and 2267 (2030) dentists and specialists were forecasted. Access to oral health services should be ensured through the optimum supply of trained dentists and specialists and the delivery of appropriate oral health services. Thus, the roadmap provided for upscaling the oral health services recognizes the influence of both demand and supply factors on the pursuit of equity.

Reflecting on the current scenario and forecasting the future demand for medical doctors in South Africa up to 2030: towards equal representation of women.

BACKGROUND: Increasing feminization of medical professions is well-acknowledged. However, this does not always equate to equitable representation of women within medicine, regarding their socio-demographic indicators, regions, sectors and fields of practice. Thus, this paper quantifies the gap in supply of female medical doctors in relation to demand, towards reaching different gender equity scenarios. METHODS: A retrospective review of the Health Professions Council of South Africa's (HPCSA) database on registered medical doctors (medical practitioners and medical specialists) from 2002 until 2019 was utilized as an indicator of supply. Descriptive statistics were used to summarize data, and inferential statistics (considering a significance level of 0.05) were utilized to determine the association between the number of male and female doctors, disaggregated by demographic variables. We forecasted future gaps of South African male and female doctors up to 2030, based on maintaining the current male-to-female ratio and attaining an equitable ratio of 1:1. RESULTS: While the ratio of female doctors per 10 000 population has increased between 2000 and 2019, from 1.2 to 3.2, it remains substantially lower than the comparative rate for male doctors per 10 000 population which increased from 3.5 in 2000 to 4.7 in 2019. Men continue to dominate the medical profession in 2019, representing 59.4% (27,579) of medical doctors registered with the HPCSA with females representing 40.6% (18,841), resulting in a male-to-female ratio of 1:0.7. Female doctors from the Black population group have constantly grown in the medical workforce from 4.4% (2000), to 12.5% (2019). There would be a deficit of 2242 female doctors by 2030 to achieve a 1:1 ratio between male and female medical doctors. An independent-samples t-test revealed that there was a significant difference in the number of male and female doctors. The Kruskal-Wallis test indicated that there was a sustained significant difference in terms of the number of male and female doctors by population groups and geographical distribution. CONCLUSIONS: Based on the investigation, we propose that HRH planning incorporate forecasting methodologies towards reaching gender equity targets to inform planning for production of healthcare workers.

Demographic transformation of the physiotherapy profession in South Africa: A retrospective analysis of HPCSA registrations from 1938 to 2018.

RATIONALE, AIM AND OBJECTIVE: The physiotherapy profession did not escape the effects of racially based segregatory practises. While numerous strategies and initiatives have been employed to redress the inequities of the past, the extent of demographic transformation within the physiotherapy profession in South Africa remains uncertain. Transformation is defined in this article as an intentional change aimed at addressing inequalities and the ultimate goal is for population group and gender profiles of higher education graduates to be representative of the national epidemiological profile. This paper describes the demographic patterns of Health Professions Council of South Africa (HPCSA) registered physiotherapists from 1938 to 2018. METHOD: A retrospective record review of the HPCSA database from 1938 until 2018 was performed. De-identified data were extracted, coded and analyzed for descriptive purposes. Z-tests were used for analysis of proportion differences, along with P-values and 95% confidence intervals for interpretation. RESULTS: In 2018, 7663 physiotherapists (6350 women and 1313 men) were registered with the HPCSA. Most registered physiotherapists (55.6%) were classified as white, followed by black (17.3%), coloured (10.3%) and Indian (9.8%). A progressive increase was found in the number of new registrations over time (1949-2018) by black (0.00%-24.38% of total new registrations), coloured (0.00%-15.47%) and Indian individuals (0.00%-10.03%), with a statistically significant increase in newly registered black therapists in the decade prior to 2018 (P = .005). Gender transformation appears to be occurring at a slower pace as the profession remains female-dominated (82.9% of registered physiotherapists in 2018). CONCLUSION: There has been a steady transformation of the South African physiotherapy graduates composition regarding population categories and gender. However, it is clear that much more than selection criteria is needed to transform the profession in a way that is nationally representative, remain actively accountable for transformation and apt for local context.

A human resources for health analysis of registered family medicine specialists in South Africa: 2002-19.

BACKGROUND: In South Africa, there is a need to clarify the human resources for health policy on family physicians (FPs) and to ensure that the educational and health systems are well aligned in terms of the production and employment of FPs. OBJECTIVE: To analyse the human resource situation with regard to family medicine in South Africa and evaluate the requirements for the future. METHODS: A retrospective review of the Health Professions Council of South Africa's (HPCSA) database on registered family medicine practitioners from 2002 until 2019. Additional data were obtained from the South African Academy of Family Physicians and published research. RESULTS: A total of 1247 family medicine practitioners were registered with the HPCSA in 2019, including 969 specialist FPs and 278 medical practitioners on a discontinued register. Of the 969, 194 were new graduates and 775 from older programmes. The number of FPs increased from 0.04/10 000 population in 2009 to 0.16/10 000 in 2019, with only 29% in the public sector. On average, seven registrars entered each of nine training programmes per year and three graduated. New graduates and registrars reflect a growing diversity and more female FPs. The number of FPs differed significantly in terms of age, gender, provincial location and population groups. CONCLUSIONS: South Africa has an inadequate supply of FPs with substantial inequalities. Training programmes need to triple their output over the next 10 years. Human resources for health policy should substantially increase opportunities for training and employment of FPs.

Planning the oral health workforce: Time for innovation.

The levels and types of oral health problems occurring in populations change over time, while advances in technology change the way oral health problems are addressed and the ways care is delivered. These rapid changes have major implications for the size and mix of the oral health workforce, yet the methods used to plan the oral health workforce have remained rigid and isolated from planning of oral healthcare services and healthcare expenditures. In this paper, we argue that the innovation culture that has driven major developments in content and delivery of oral health care must also be applied to planning the oral health workforce if we are to develop 'fit for purpose' healthcare systems that meet the needs of populations in the 21st century. An innovative framework for workforce planning is presented focussed on responding to changes in population needs, service developments for meeting those needs and optimal models of care delivery.

A Situational Mapping Overview of Training Programmes for Community-Based Rehabilitation Workers in Southern Africa: Strategies for Strengthening Accessible Rural Rehabilitation Practice.

In 2018, the United Nations global report showed that people with disabilities, who make up 15% of the worlds' population, have poorer health and rehabilitation access (SDG 3). Without improving the needed person-centered health and rehabilitation services at household level, SDG 3 cannot be achieved. This includes addressing human resource shortages through training multi-skilled community based rehabilitation workers (CRWs) to build rural workforce capacity and enhance the lives of people with disabilities, particularly in LMICs where the need is higher but resources are lower. However, to date, there is no documentation and analysis of existing training and its scope for this workforce in LMICs. A situational mapping overview was undertaken to review the current status of rural rehabilitation training programs offered in Southern Africa for CRWs. CRWs are rehabilitation personnel, based in the home/community, who are not professionals (without a bachelor qualification) but render non-institutional rehabilitation and inclusive development in communities, under the supervision of rehabilitation practitioners. Information on these programs was obtained using a two-step process. Firstly, a descriptive list of university courses for rehabilitation workers offered in the Southern African countries was collected via an internet and literature search. Secondly, detailed information about the disability and rural rehabilitation courses was collected from the respective institutions and their designated websites. There are six training courses targeted at CRWs or disability practitioners with a disability focus being offered at universities in Southern Africa, five of these in South Africa and one in Zimbabwe. Additionally, four training courses are offered as online/open resources by global organizations and are self-directed with no accreditation. While other key competencies feature, none of these programmes' learning outcomes make direct reference to the rural practice context and its complexities in relation to disability and poverty. The situational mapping overview shows limited training targeted at CRWs in Southern Africa, to effectively facilitate rural rehabilitation, poverty reduction and social inclusion. There is a need for an articulated community-orientated rural training to respond to the unmet needs. This may require a different set of competencies and assessment standards for trainees as well as additional competencies for their supervisors and mentors.

Mechanical Debridement with Antibiotics in the Treatment of Chronic Periodontitis: Effect on Systemic Biomarkers-A Systematic Review.

In this systematic review, we assessed the effectiveness of systemic antibiotics as an adjunctive therapy to mechanical debridement in improving inflammatory systemic biomarkers, as compared to mechanical debridement alone, among adults with chronic periodontitis. We searched relevant electronic databases for eligible randomized controlled trials. Two review authors independently screened, extracted data, and assessed risk of bias. We conducted meta-analysis, assessed heterogeneity, and assessed certainty of evidence using GRADEPro software. We included 19 studies (n = 1350 participants), representing 18 randomized controlled trials and found very little or no impact of antibiotics on inflammatory biomarkers. A meta-analysis of eight studies demonstrated a mean reduction of 0.26 mm in the periodontal pockets at three months (mean difference [MD] -0.26, 95%CI: -0.36 to -0.17, n = 372 participants, moderate certainty of evidence) in favor of the antibiotics. However, results from five studies reporting clinical attachment level (mm) yielded little or no difference at three months (MD -0.16, 95% CI: -0.35 to 0.03, n = 217 participants) between antibiotic and placebo groups. There is little or no evidence that adjunctive systemic antibiotics therapy improves inflammatory systemic biomarkers, compared to mechanical debridement alone, among adults with chronic periodontitis.

A systematic review of vaccine availability at the national, district, and health facility level in the WHO African Region.

INTRODUCTION: To describe vaccine stock-outs at national, district, and health facility levels in the WHO African region. AREAS COVERED: We conducted a systematic review to identify studies reporting on vaccine stock-outs at national, district, and health facility levels in 47 African countries. We searched both published and unpublished literature, including the WHO/UNICEF Joint Reporting Form (JRF), for eligible studies. EXPERT OPINION: Countries within the WHO African region continue to face the challenge of vaccine stock-outs at national, district, and health facility levels and this impacts on the delivery of immunization services. The frequency and the proportion of stock-outs vary between countries and between regions within a country. Countries need to put more efforts toward finding lasting solutions to vaccine shortages. We look forward to having more countries reporting vaccine stock-outs especially at the health facility level. Furthermore, countries are currently exploring different approaches for improving vaccine stock management. It is expected that in half a decade from now, more well-designed studies will be available that will inform decision-making.

Exploring national human resource profile and trends of Prosthetists/Orthotists in South Africa from 2002 to 2018.

BACKGROUND: The World Health Organization (WHO) in 2017 estimated that around 35-40 million people require prosthetic or orthotic services. The Framework and Strategy for Disability and Rehabilitation 2015-2030 for South Africa highlights a shortage of human resources for disability and rehabilitation services to manage the various risks and types of impairments faced by the population. OBJECTIVE: To describe the demographic trends of Prosthetists/Orthotists (P/O) registered with the Health Professions Council of South Africa (HPCSA) from 2002 to 2018. METHODS: The study was a retrospective record-based review of the Health Professions Council of South Africa (HPCSA) database from 2002 until 2018. The database of registered Prosthetists/Orthotists was obtained from the HPCSA. RESULTS: Data were analysed using the Statistical Package for the Social Sciences (SPSS version 22.0). In 2018, there were 544 P/Os registered with the HPCSA with a ratio of 0.09 P/Os per 10,000 population. There has been an average annual increase of 6% from 2002 to 2018. The majority (71.9%) of P/Os are located in the more densely populated and urbanized provinces, namely Gauteng, KwaZulu-Natal and Western Cape. The majority of registered P/Os identified as white (61%) followed by Black (22%), Indian (7%) and Coloured (2%). Most of registered P/Os are under the age of 40 years (54.2%) and males make up 73% of the registered P/Os. CONCLUSION: This study highlights the unequal spatial distribution trends of P/Os which could be accounted for by South Africa's apartheid history and the subsequent slow pace of transformation. Addressing the existing shortages is necessary to expand access to P/Os services and to ensure the motivation, planning and provision of adequate infrastructure to provide these services. The study presents a compelling case for the prioritization and strengthening of this workforce for the achievement of effective universal health coverage for persons with disabilities.

Sustainable workforce: South African Audiologists and Speech Therapists.

BACKGROUND: Audiologists and Speech Therapists play a vital role in addressing sustainable development goals by supporting people who are marginalised due to communication challenges. The global burden of disease and poor social living conditions impact negatively on the development of healthy communication, therefore requiring the services of Audiologist and Speech therapists. Against this background, we examined the demographic profile and the supply, need and shortfall of Audiologists and Speech Therapists in South Africa. METHODS: The data set was drawn from the Health Professions Council of South Africa (HPCSA) registers (for 2002-2017) for the speech, language and hearing professions. This demographic profile of the professions was created based on the category of health personnel; category of practice, geographical location, population group (race) and sex. The annual supply was estimated from the HPCSA database while the service-target approach was used to estimate need. Additional need based on National Health Insurance Bill was also included. Supply-need gaps were forecast according to three scenarios, which varied according to the future intensity of policy intervention to increase occupancy of training places: 'best guess' (no intervention), 'optimistic' (feasible intervention), and 'aspirational' (significant intervention) scenarios up to 2030. RESULTS: Most (i.e. 1548, 47.4%) of the professionals are registered as Audiologists and Speech Therapists, followed by 33.5% registered as Speech Therapists and 19.1% registered as Audiologists. Around 88.5% professionals registered as Audiologists and Speech Therapists are practising independently, and 42.6% are practising in the Gauteng province. The profession is comprised majorly of women (94.6%), and in terms of the population groups (race), they are mainly classified as white (59.7%). In 2017, in best guess scenario, there is a supply-need gap of around 2800 professionals. In the absence of any intervention to increase supply capacity, this shortfall will remain same by the year 2030. By contrast, in aspirational scenario, i.e. supply is increased by 300%, the forecasted shortfall for 2030 reduces to 2300 from 2800 professionals. CONCLUSIONS: It is clear that without significant interventions, South Africa is likely to have a critical shortfall of Audiologists and Speech Therapists in 2030. Policy-makers will have to carefully examine issues surrounding the current framework regulating training of these and associated professionals, in order to respond adequately to future requirements.