More doctors and dentists are needed in South Africa.
Abstract: Background. An aim of the Colleges of Medicine of South Africa (CMSA) project 'Strengthening Academic Medicine and Specialist Training' was to research the number and needs of specialists and subspecialists within South Africa.

Methods. Data were collected from several sources: Deans of the 8 Faculties of Health Sciences and the Presidents of the 27 constituent Colleges of the CMSA completed a survey; and the HPCSA's Register of Approved Registrar Posts for Faculties of Health Sciences was examined and the results tabulated.

Results. South Africa compares unfavourably with middle-income countries on the ratios of medical and dental professionals; many districts have limited access to specialists and subspecialists. The unacceptable ratio of doctors, dentists and other health professionals per capita needs to be remedied, given South Africa's impressive reputation for its output of health professionals, including the areas of medical training, clinical practice and clinical research. The existing output from South Africa's 8 medical schools of MB ChB and specialist graduates is not being absorbed into the public health system, and neither are other health professionals.

Conclusion. Dynamic leadership and policy interventions are required to advocate and finance the planned increase of medical, dental and other health professionals in South Africa.

S Afr Med J 2011;101:523-528.
Article Type: Report
Subject: Medical colleges (Forecasts and trends)
Medical colleges (Services)
Dentists (Supply and demand)
Physicians (Supply and demand)
Public health administration (Research)
Medical personnel (Training)
Medical personnel (Forecasts and trends)
Medical personnel (Management)
Authors: Strachan, B.
Zabow, T.
van der Spuy, Z.M.
Pub Date: 08/01/2011
Publication: Name: South African Medical Journal Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 South African Medical Association ISSN: 0256-9574
Issue: Date: August, 2011 Source Volume: 101 Source Issue: 8
Topic: Event Code: 010 Forecasts, trends, outlooks; 360 Services information; 600 Market information - general; 310 Science & research; 200 Management dynamics Computer Subject: Market trend/market analysis; Company business management
Product: Product Code: 8021000 Dentists; 8011000 Physicians & Surgeons NAICS Code: 62121 Offices of Dentists; 621111 Offices of Physicians (except Mental Health Specialists)
Geographic: Geographic Scope: South Africa Geographic Code: 6SOUT South Africa
Accession Number: 263519606
Full Text: In 2008, the Colleges of Medicine of South Africa (CMSA) initiated a project entitled 'Strengthening Academic Medicine and Specialist Training' as a response to the concern among medical and dental professionals about increasing challenges in the academic training environment and issues relating to the output and retention of specialists and sub-specialists in the public health services. These challenges significantly affect the capacity of the public and private health sectors to provide South Africa's required quality of health care and to ensure the output of sufficient health professionals to meet its needs.

A prime aim of the CMSA project was to research the need for, and numbers of, specialists and subspecialists within South Africa; this is ongoing, and the initial results are presented herein.

Objectives

The objectives of the CMSA project were to:

* compare South Africa internationally regarding the number of doctors and dentists per 1 000 population

* establish the number of specialists and subspecialists in South Africa

* establish whether these numbers meet South Africa's healthcare requirements

* identify the cost of registrar training should finances be needed to increase the output

* develop an Excel model and database to capture and monitor data on specialists and subspecialists by discipline and Faculty.

Methods

Data were collected from the following sources:

* World Health Organization (WHO) country data on medical doctors and dental personnel.

* Public and private sources of data in South Africa on health professionals included the National Department of Health (DOH), CMSA, National Treasury, Health Professions Council of South Africa (HPCSA), a large private funder, Board of Healthcare Funders (BHF), South African Medical Association (SAMA) and Medpages.

* The deans of the eight faculties of health sciences were asked to complete a survey in 2009. The objectives were to determine:

* existing figures for filled HPCSA specialist and subspecialist training posts

* why HPCSA training numbers have not been translated into filled posts e.g. because of unfunded or inadequate recruitment

* what additional specialist registrar training numbers are needed, and what increase is recommended for specialists, sub-specialists and dental specialists

* capacity and staffing requirements to train specialists, subspecialists and dental specialists, and how to meet future staffing needs.

* The Presidents of the then 27 constituent colleges of the CMSA in 2009 were sent the available data and asked to complete a survey. They were informed that the outcome of the exercise was a practicable and pragmatic plan to increase the output of specialists and sub-specialists and that the survey was the first step. They were asked to:

* agree or disagree with the figures provided (and make adjustments)

* suggest an ideal staffing situation, and a pragmatic increase which would address, in part, health care needs

* motivate the reasons for the increase

* make any other suggestions about staffing requirements.

* The HPCSA's Register of Approved Registrar Posts for health sciences faculties was examined and results tabulated. This register is based on HPCSA accreditation site visits and includes approved training numbers for specialists and sub-specialists.

Results

WHO data

South Africa compares unfavourably with other middle-income countries in terms of medical and dental professionals per 1 000 population. In 2008,1 South Africa had 0.77 physicians (medical professionals) per 1 000 population, compared with Brazil (1.85), Mexico (1.8), the UK (2.47) and Australia (2.3) (Table I). The UK has 120 000 doctors for a population of 60 million; South Africa, with a population of 48 million, has 27 000 doctors. South Africa compares very unfavourably with other countries in terms of dentistry personnel (only 0.13 per 1 000 population) (Table I), compared with Brazil (1.16) and Mexico (1.42).

South African figures for doctors and dentists per 1 000 population

Several data sources were studied to establish the number of doctors and dentists in South Africa (Tables II--V). A 'best guess' estimate involved reviewing and collating data from various sources. This once-off effort is a useful exercise, but is limited as data quickly become outdated.

In 2009 there were about 9 765 medical specialists in the South African health sector--5 532 in the private and 4 233 in the public sector. There are an estimated 14 814 medical professionals in the public sector (0.36 per 1 000 population) and 12 827 in the private sector (1.70 per 1 000 population), giving a total of 27 641 (0.57 per 1 000 population). This is a lower ratio than the WHO data in Table I (0.77 per 1 000).

Tables II and III show the results of data searching on numbers of doctors in South Africa in 2009.

A 'best guess' of dentists in South Africa revealed extremely low numbers of dentists and a low ratio per 1 000 population. There were 4 153 dentists (0.085 per 1 000 population) and few or no posts available to them in the public sector. The Community Dentistry speciality is a particular concern, with only 8 posts identified in South Africa (personal communication: Medpages 2011; Dr Barrie, UWC School of Dentistry, January 2011).

Survey of Deans of Faculties of Health Sciences 2009

The 2009 CMSA survey results of Deans of Faculties of Health Sciences are reported in Tables V--VII; 72.43% of HPCSA-approved registrar posts were filled, and only 53% of sub-specialist training posts were filled. Deans prioritised the funding and filling of existing posts before considering plans for expansion, but nevertheless proposed an increase of 8% for specialist trainees and 22% for subspecialist trainees. Deans provided motivation by speciality and sub-specialty for the proposed increases, and identified matters for consideration that affect expansion of specialist and sub-specialist output (Table V).

The numerical results of the deans' survey are summarised in Tables VI and VII. Table VII presents the results of the survey of dental deans. Despite the significant shortage of dental specialists, only 62% of dental specialist registrar training posts are filled.

Survey of Presidents of Constituent Colleges of the CMSA 2009

Table VIII summarises the responses to the survey of the Presidents of the constituent colleges of the CMSA. They recommended that a pragmatic increase would be from 8 743 to 13 614 specialists (56% increase). The Presidents suggested that the total number of specialists in the public and private sectors was 8 743, which differs from the figures in Table III that show a 'best guess' of 9 765--or 10 229 according to HPCSA data. The difference is possibly due to double counting of specialists working in the public and private sectors, non-practising/retired specialists, and emigrants.

Review of the HPCSA 'Register of Approved Registrar Posts'

The HPCSA 'Register of Approved Registrar Posts' was analysed in 2010. Tables IX and X show data from HPCSA reports of site visits that recorded the total number of accredited registrar and sub-specialist training posts, and unfilled training posts; 38% of specialist and 75% sub-specialist training posts were unfilled. The HPCSA register numbers differ from the Deans' survey in Tables VI and VII, which could be due to the year in which the Faculty was visited by the HPCSA, and other factors. To implement a plan for the filling of training posts, Faculty and HPCSA data must be reconciled.

Costs of filling unfilled HPCSA training posts

The costs of filling unfilled HPCSA training posts were calculated (personal communication: Dr Mark Blecher, Social Sector National Treasury). Table XI shows the total cost of filling unfilled specialist and sub-specialist training posts over 5 years. Costs were calculated using only the costs of the registrar salary for a training period of 4 years for registrars and 2 years for sub-specialists (with a 6% cumulative annual increase for inflation). The costs of the service sites where they are trained are not included as they are assumed to be academic site health-service costs and not part of the dedicated financing required for specialist and sub-specialist trainee salaries.

These costs must be taken into account but through a different funding stream. Academic clinician costs were also calculated for each speciality and sub-specialty. Not all newly filled registrar and sub-specialist training posts will require academic clinician appointments. The academic supervision cost per trainee based on 2009 salaries, and over 4 years, is R1 million to R1.5 million, depending on the speciality. Funds for registrar training posts should be ring-fenced to protect their training in line with national needs for medical and dental practitioners.

Discussion

Our study demonstrates that South Africa has a poor ratio of doctors and dentists per 1 000 population, and many districts have limited or no access to specialist medical and dental services. The situation should never have developed. South Africa employs relatively few of its doctors and dentists in the public sector, and loses many to emigration.

From 1997 to 2006, there was a significant decline of 854 (25%) specialists and sub-specialists in the public sector (from 3 782 to 2 928). The number of medical practitioners (non-specialist) on the public sector payroll increased in the same period from 9 184 to 9 958, an increase of only 774 in 10 years (personal communication: Dr Nicholas Crisp, Benguela Health, 2010). The decline in specialists and sub-specialists, and limited increase in medical professionals in the public sector over 10 years, must be seen against the output of MB ChB and specialist graduates in South Africa. Table XII shows the graduates produced during the period 1998--2006, when specialist and generalist numbers on the public sector payroll were declining and stagnating. Over 9 years, 14 145 MB ChB and specialist graduates were produced.

These graduates are not being recruited into the public sector system; the reasons include: lack of policy to expand the number of medical professionals in the public sector; lack of planning; lack of finance and posts; poor working environment and working conditions; and very limited--to non-existent--career prospects in the public health services. (2)

A significant contributor to low retention has been lack of positive reinforcement for 15 years from DoH authorities to doctors. Doctors often feel undervalued, and some policy and financing incentives support this perception. The South African health and education system has, by omission and commission, implemented 'push factors' which send doctors away (Table XIII). (3)

The first step to improve management of staff needs for the South African health sector is to have a reliable database that supplies the numbers of health professionals, and trends in output and retention. The present study showed that there is no accurate and reliable database of health professionals, with information on location and type of employment, active or inactive, emigrated, etc. Therefore, trends are not monitored. Key trends are that the number of public sector specialists is declining despite an annual output of about 500, and only a tenth of medical graduates are absorbed into the public sector.

A central data source on medical, dental and other health professionals, which is monitored and updated annually, is urgently needed. It should be used to ensure planning and development of specialists, monitor placement and emigration, plan recruitment, and review specialist service activity. Such a database should be developed by collaboration between the parties who provided data for this research, and be publicly available. Examples of international electronic databases include the UK's www.specialistinfo.com and the Australian www.healthdirectory.com.au/medicalspecialists.

Table XIV details the data sources reviewed and their strengths and weaknesses. No single source is adequate for providing comprehensive data on health professionals.

Conclusion

Dynamic leadership and policy interventions are required to advocate and finance the planned growth of medical, dental and other health professionals, including specialists and sub-specialists. This effort must be accompanied by a strategy to retain doctors, careful assessment of working conditions, and active recruitment of doctors who have left the country and of foreign doctors who can contribute to South African health care development. (5,6) The policy priority should be to consolidate training capacity by planning and funding the existing recommended HPCSA training posts within faculties of health sciences, and to send a positive message to South African doctors and dentists that the country values and needs them.

Postscript. As a result of the CMSA's project work in 2010, National Treasury agreed this year to allocate funds for filling unfilled registrar training posts over 5 years, as detailed and costed in this article.

Acknowledgement

The CMSA expresses its appreciation to funders for supporting this research that was part of its project 'Strengthening Academic Medicine and Specialist Training'. Funding was initiated through the CMSA Foundation (new Board of Trustees). The Discovery Foundation funding allowed development of the project and significant research. Other funders were the Medi-Clinic Hospital Group, Netcare Hospital Group, Metropolitan Health Group, Medscheme Health Risk Management, Old Mutual Health Risk Management, and Medical Advisors Groups of SAMA.

Accepted 17 June 2011.

References

(1.) World Health Organization. WHO Statistical Information System (WHOSIS). http://www.who.int/ whosis/indicators/compendium/2008/4mrn/en/index.html (accessed 15 March 2010).

(2.) Pendleton W, Crush J, Lefko-Everett K. The Haemorrhage of Health Professionals from South Africa: Medical Opinions. Cape Town: IDASA, 2007:2,6.

(3.) Ibid.:17.

(4.) Buchan J. Migration of Health Workers in Europe: Policy Problem or Policy Solution. In: Du Bois C, McKee M, Nolte E, eds. Human Resources for Health in Europe. Maidenhead, Berks., UK: Open University Press, 2006:44-52.

(5.) Mullan F, Frehyot S, Omaswa F, et al. Medical schools in sub-Saharan Africa. Lancet 2011;377(9771):1113-1121.

(6.) Collins FS, Glass RI, Whitescarver J, Wakefield M, Goosby E. Developing health workforce capacity in Africa. Science 2010;330(6009):1324-1325.

B Strachan, BSc Hons, MA, PhD, MSc

T Zabow, MB ChB, DPM, FCPsych (SA), MRCPsych (UK)

Colleges of Medicine of South Africa, Cape Town

Z M van der Spuy, PhD, MB ChB, FRCOG, FCOG (SA)

Immediate Past President of Colleges of Medicine of South Africa; Department of Obstetrics and Gynaecology, University of Cape Town

Corresponding author: B Strachan (bstrachan@telkomsa.net)
Table I. Comparison of practising physicians and dental
personnel, GNP per capita and health expenditure (WHO 2008)

                            Dental
               Physicians   personnel   GNP per       Health exp as
Country        per 1 000    per 1 000   capita in $   % total exp

Lesotho        0.05         0.01        1 810         6.7
South Africa   0.77         0.13        8 900         8.6
Brazil         1.85         1.16        8 700         7.5
Mexico         1.98         1.42        11 990        6.2
USA            2.56         1.63        44 070        15.3
Greece         5            1.32        30 870        9.9
UK             2.3          0.52        33 650        8.4
Australia      2.47         0.69        33 940        8.7

Exp=expenditure.

Dentistry personnel includes dentists, dental assistants,
dental technicians and related occupations.

Table II. Medical specialists and general
practitioners, South Africa 2009

                                          General practitioners

Data source                   Public sector   Private sector   Total

Medpages                      1 780           8 461            10 568
Large private sector funder                   7 295            7 295
BHF
HPCSA and CMSA                                                 21 079
SAMA members                                                   18 165
Persal public sector          10 581
Best guess                    10 581          7 295            17 876

                                           Medical specialists

Data source                   Public sector   Private sector   Total

Medpages                      1 788           4 314            6 188
Large private sector funder                   5 532            5 532
BHF                                           4 178            4 178
HPCSA and CMSA                                                 10 229
SAMA members                                                   6 338
Persal public sector          4 233
Best guess                    4 233           5 532            9 765

Table III. Total general practitioners and medical specialists
in the public and private sectors, South Africa 2009

                        Public sector   Private sector   Total

Medpages                3 568           12 775           16 756
Large private sector
funder                  0               12 827           12 827
BHF                     0               4 178            Not
                                                         complete
HPCSA and CMSA          0               0                31 308
SAMA                    0               0                24 503
Persal public sector    14 814                           14 814
Best guess              14 814          12 827           27 641
Population              41 127 928      7 552 820        48 680 749
Per 10 000 population   3.6             17               5.7
Per 1 000 population    0.36            1.70             0.57

Table IV. General practitioner dentists and specialists in the
public and private sectors, South Africa 2009

                             Public sector   Private sector   Total

GP dentists
Medpages                                     2 881
NDoH unpublished Persal
payroll                      1 086
Best guess                   1 086           2 881            3 767
Per 1 000 population         0.026           0.381            0.077

Specialist dentists
Medpages                     28              240
CMSA survey 2009             146             240              386
Best guess                   146             240              386
Per 1 000 population         0.004           0.032            0.008
Total best guess             1 032           3 121            4 153
Total per 1 000 population   0.025           0.413            0.085

Table V. CMSA 2009 survey of Deans of Faculties of Health
Sciences: Issues that affect growth in specialist and sub-specialist
training

* Lack of funds for registrar, sub-specialist and consultant posts

* Staffing issues: Need for better staff remuneration and career
planning; slow staff appointments must be facilitated; posts and
filling of posts are the problem, not staff availability; various
strategies must be used for staff recruitment; staff shortages owing
to the shrinkage of academic clinical staff and job opportunities;
improve faculty staffing partly with more private sessions

* Provincial departments of health have too much control over
the appointment of academic staff

* Health service providers and provincial departments of
health could be more accommodating of the needs for clinical
specialist training

* Lack of retention of young doctors

* Trainees must be allowed to rotate through the private sector,
honorary consultant posts be established for private sector
specialists, and 'academic chairs' should be sponsored by the
private sector

* The public and private sectors should work together as a
partnership with training in both sectors

* Training is threatened in the public sector owing to
infrastructure, staff issues and reduced theatre time

* Faculties of health sciences should collaborate and circulate
professors who head centres of excellence, or rotate registrars
through centres of excellence across the country

* There is a need for a national forum and transparent national
process which allows discussion and decision making, and that
has access to ring-fenced funding and information

Table VI. CMSA deans' survey: Filled and vacant HPCSA medical
training post figures, and proposed increase, by faculty, 2009

             UCT     US      Wits    UP      UKZN

Vacant       116     80      173     97      293
Filled       368     308     673     309     611
Total        484     388     846     406     904
% filled     76%     79.4%   79.6%   76.1%   67.6%
Increase     100     30      161     22      4
% increase   20.7%   7.7%    19%     5.4%    0.4%

             FS      UL      WSU     Total

Vacant       63      126     89      1 037
Filled       226     167     63      2 725
Total        289     293     152     3 762
% filled     78.2%   57%     41.5%   72.4%
Increase     39      0       0       356
% increase   13.5%   0%      0%      9.5%

Table VII. CMSA deans' survey: Filled and vacant HPCSA dental
training post numbers and proposed increase by faculty, 2009

                                     Registrar posts

Totals                            Vacant   Filled   Total

Community dentistry               10       7        17
Maxillo-facial and oral surgery   4        23       27
Oral medicine and periodontics    8        8        16
Oral pathology                    5        6        11
Orthodontics                      12       16       28
Prosthodontics                    6        16       22
Totals                            45       76       121

                                        Registrar posts

Totals                            % filled   Increase   % increase

Community dentistry               41.2%      0          0%
Maxillo-facial and oral surgery   85.2%      1          3.7%
Oral medicine and periodontics    50%        2          12.5%
Oral pathology                    55%        0          0%
Orthodontics                      57.1%      0          0%
Prosthodontics                    72.7%      2          9.1%
Totals                            62.8%      5          4.1%

Table VIII. CMSA survey 2009: Total number of specialists in the
public and private sectors and a recommended pragmatic increase
to meet healthcare requirements

                               EC      FS     GA      KZ      LI

Public and private             533     494    3 560   1 312   149
Public                         249     262    1 289   604     85
Private                        284     232    2 271   708     64
Ratio/10 000 population 2008   0.81    1.72   3.41    1.30    0.28
Ratio/population pragmatic     2.00    2.41   4.46    2.47    1.35
Actual numbers pragmatic       1 317   694    4 657   2 498   713

                               MP     NC     NW     WC      Totals

Public and private             202    72     218    2 203   8 743
Public                         60     27     46     1 015   3 637
Private                        142    45     172    1 188   5 106
Ratio/10 000 population 2008   0.56   0.64   0.64   4.19    1.50
Ratio/population pragmatic     1.41   1.54   1.58   4.79    2.44
Actual numbers pragmatic       506    173    540    2 518   13 614

EC = Eastern Cape; FS = Free State; GA = Gauteng; KZ = KwaZulu-
Natal; LI = Limpopo; MP = Mpumalanga; NC = Northern Cape; NW =
North West; WC = Western Cape.

Table IX. Number of HPCSA-approved registrar training posts

Faculty    UCT   US    Wits   UP    UKZN   FS    UL    WSU   Total

Vacant     148   63    210    126   433    56    148   169   1 353
Filled     299   287   568    260   436    214   159   6     2 229
Total      447   350   778    386   872    270   307   175   3 582
% filled   67%   82%   73%    67%   50%    79%   52%   3%    62%

Note: HPCSA sites visits were undertaken between 2008 and 2010.

Table X. Number of HPCSA-approved sub-specialist training
posts

           UCT   US    Wits   UP   UKZN   FS   UL   WSU   Total

Vacant     49    62    59     69   42     29   43   27    380
Filled     29    24    53     0    8      2    0    0     116
Total      78    86    112    69   50     31   43   27    496
% filled   37%   28%   53%    0%   16%    6%   0%   0%    25%

HPCSA sites visits were undertaken between 2008 and 2010.

Table XI. Cost of filling unfilled trainee specialist
and sub-specialist training posts, 2010

                                    Year

                     1              2              3

Trainees             305            645            985
Total annual costs   R198 468 623   R462 805 132   R683 058 919

                              Year

                     4              5

Trainees             1 330          1 382
Total annual costs   R934 763 254   R1 018 901 474

Sub-specialist trainees are paid at specialist rates, unless sub-
specialty is studied in registrar years 3 and 4. Overtime and the
2010/2011 salary increase are included.

Table XII. Specialist and MB ChB graduates 1998-2006

       Graduate specialists   Graduate MB ChBs    Total

1998           263                 1 131          1 394
1999           304                 1 131          2 829
2000           298                 1 131          4 258
2001           285                 1 229          5 772
2002           306                 1 212          7 290
2003           324                 1 296          8 910
2004           335                 1 394         10 639
2005           321                 1 511         12 471
2006           308                 1 366         14 145

Source: Personal communication DHET and CMSA, 2010.

Table XIII. Main push and pull factors in migration
and international recruitment of health workers (4)

Push factors                   Pull factors

Low pay (absolute and/or       Higher pay and opportunities for
relative)                      remittances

Poor working conditions        Better working conditions

Lack of resources to work      Better-resourced health systems
effectively

Limited career opportunities   Career opportunities

Limited educational            Provision of post-basic education
opportunities

Impact of HIV and AIDS         Political stability

Unstable/dangerous working     Travel opportunities
environment

Economic instability           Aid work

Table XIV. Sources of South African data on medical and dental
specialists, and medical practitioners (non specialist)

Data source            Quality of data

Persal public          Persal system from National Treasury is an
sector payroll         accurate source of data on existing medical
                       professionals on the public sector payroll, but
                       only records job category and broad profession.
                       Its lack of recording the type of medical or
                       dental specialist can be corrected by the DoH
                       requesting provincial health departments to use
                       a standard set of job titles in existing job
                       categories. Data are captured inconsistently by
                       existing fields for geographical and workplace
                       location and employer. Provincial departments
                       of health could be required annually to submit
                       this refined data on medical, dental and other
                       health professionals, in a standard format to
                       the DoH or other central source.

HPCSA                  The HPCSA records the registration of
                       specialist medical personnel and other health
                       professionals in specific disciplines so that
                       they can practise, but does not monitor numbers
                       of health professionals in the health system.
                       Therefore, its database has limitations as an
                       accurate source of numbers of individual
                       specialists in the health system, and has no
                       available data by practitioner and their work
                       location in the public or private sector.
                       Registrars are registered separately. The data
                       are an overestimate as there is double counting
                       of specialists who are on 2 or more registers.
                       HPCSA data duplicate public and private sector
                       figures, include people who have emigrated and
                       who no longer practise, and does not record
                       individual and practice details. The utility of
                       HPCSA data could be improved by refining the
                       annual registration form and ensuring that the
                       data can be analysed annually in a relevant
                       format. Extending the current HPCSA database
                       capture has resource implications.

CMSA                   The CMSA database includes only members of the
                       CMSA and not specialists who are not members.
                       CMSA data do not include details of where
                       specialists work. This research checked CMSA
                       and HPCSA data against each other and used a
                       single figure for the results.

Medpages               Medpages (www.medpages.co.za) is a live
                       database that is regularly updated and
                       maintained by a private service provider. It
                       was developed to service private sector
                       suppliers such as pharmaceutical companies.
                       Medpages data on private sector providers and
                       practitioners are accurate to within 95%. It
                       records speciality and sub-speciality and
                       area/s of interest. Medpages separates
                       non-practising and emigrated practitioners and
                       public, private and limited private practice;
                       and identifies physical location of practices
                       and academics in the public and private
                       sectors. As Medpages had no access to
                       information on medical professionals working in
                       the public sector at the time of the research,
                       their data are less accurate than their data on
                       the private sector.

BHF                    BHF data did not have the relevant data
                       required.

SAMA                   SAMA data records only medical practitioners
                       who are members, but includes non-practising
                       practitioners.

Large private sector   A large private sector administrator/funder
administrator/funder   that has an accurate data base of types of
                       specialists and the specialists' practice
                       address was used to establish numbers of
                       private sector specialists. Their data on types
                       of private sector specialists, and specialists
                       in the public sector who do private work, were
                       similar to Medpages'.

DoH                    The DoH does not have a live database on
                       practising medical and dental professionals in
                       the public and private sectors, or information
                       on other health professionals. To plan and
                       finance the health workforce, and manage need,
                       demand and supply, the DoH requires an accurate
                       database of health professionals, which it
                       could develop or outsource.
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