PCNS 2019/2020 Report

BOARD OF HEALTHCARE FUNDERS

2019/2020

PCNS

REPORT

1

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

GLOSSARY OF TERMS ......................................................................................................................................................... 2 EXECUTIVE SUMMARY ........................................................................................................................................................ 3 1

Introduction ................................................................................................................................................................ 5 1.1

The Practice Code Numbering System ...................................................................................................... 5

1.2

The Importance of the PCNS ........................................................................................................................ 7

2

Methods ...................................................................................................................................................................... 9

3

Limitations .................................................................................................................................................................. 9

4. Healthcare service professional providers by country ....................................................................................... 10

5

6

7

4.1

HSPP disciplines by country ....................................................................................................................... 10

4.2

HSPPs’ demographic profile by country .................................................................................................. 18

HSPPs by discipline ................................................................................................................................................. 23 5.1

Primary healthcare service ......................................................................................................................... 23

5.2

Supplementary and allied health professionals .................................................................................... 38

5.3

Specialists ....................................................................................................................................................... 51

Conclusions and recommendations ................................................................................................................... 92 6.1

Conclusions .................................................................................................................................................... 92

6.2

Recommendations........................................................................................................................................ 93

References ................................................................................................................................................................ 94

Annexure 1: Disciplines and Grouping ......................................................................................................................... 95

Copyright 2022 © Board of Healthcare Funders

2

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

AHFoZ

Association of Health Funders Zimbabwe

BHF

Board of Healthcare Funders

FP

Family Practitioners

FWA

Fraud Waste and Abuse

HFAB

Health Funders Association Botswana

HFMU

Health Forensic Management Unit

HRH

Human Resources for Health

HSP

Healthcare Service Providers

HSPP

Healthcare Service Professional Providers

NAMAF

Namibia Association of Medical Aid Funds

PCNS

Practice Code Numbering System

SADC

Southern Africa Development Community

SAHP

Supplementary and Allied Health Professionals

UHC

Universal Healthcare

WHO

World Health Organization

Copyright 2022 © Board of Healthcare Funders

3

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

This report illustrates trends in the number of healthcare service professional providers (HSPPs) registered on the Practice Code Numbering System (PCNS). It also shows trends in the distribution of HSPPs by population. These trends include the number of active providers, the movement of providers and their demographic profiles. It is important for managing human resources for health (HRH) to monitor the latter and how these change over time.

A descriptive cross-section analysis of HSPPs on the PCNS was used in analysing the data. The study included HSPPs from four different countries on the PCNS from 2019 to 2020, namely South Africa, Namibia, Zimbabwe, and Lesotho.

The number of family practitioners (FPs) increased across the four countries; similarly the number of FPs per million population increased, though at a lower rate. Lesotho and Namibia had increases of more than 5%, while South Africa and Zimbabwe had increases of below 3%. With regard to demographic profiles, most FPs were male (over 60%). The average age of FPs with active PCNS numbers increased in all countries except Lesotho. The average age was lowest in Zimbabwe (40.9 years in 2020) while it was 50.6 years in South Africa.

The movement of FPs was also analysed in terms of absolute numbers and demographic profiles.

Generally, FPs registering on the PCNS had lower average ages, ranging from 34.7 years in South Africa to 40.7 years in Lesotho. The average age of FPs de-registering was higher; it was 50.1 years in South Africa and 49.1 years in Namibia. It would be preferable to have these average ages closer to retirement ages.

Similar trends were observed for other primary care HSPPs, dentists and supplementary and allied healthcare professionals (SAHPs). There were some slight variations, e.g. the number of dentists is much lower than that of FPs. As expected, there are also many more SAHPs. The number of medical specialists with active PCNS numbers increased across all four countries, with South Africa recording a 1.8% increase while Namibia had 10.2% increase from 2019 to 2020. In terms of changes in number of medical specialists per million population, Zimbabwe had the highest growth of 9.9%, followed

by Lesotho at 8.9%. South Africa had the lowest growth at 0.3%. In 2020, South Africa had the highest number of specialists at 80.12 per million population; it was lowest in Lesotho at 5.13 per million population.

In terms of movement of medical specialists, South Africa had the highest number of registrations - 98 in 2020. New registrations were 40% lower in 2020 for South Africa; similar observations were made in the other three countries. The number of de-registrations among medical specialists increased by 350% in South Africa and 267% in Namibia.

Copyright 2022 © Board of Healthcare Funders

4

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

The average age of medical specialists with active practice numbers increased slightly across all the countries. Zimbabwe had the lowest average age of 39.7 years in 2020, while South Africa had the highest at 52 years. Zimbabwe had the highest average age of registering medical specialists at 39.6 years; it was 37.2 years in South Africa. The average age of de-registering medical specialists was 57.6 years in South Africa and 53.3 years in Namibia.

This points to a significant movement of medical specialists. Of concern is the reduction in the number of registering medical specialists and the increasing number of de-registrations. Age profile also suggests significant movement of younger medical specialists.

Generally, trends among surgical specialists are very similar to those of medical specialists. The number of surgical specialists is comparable to the number of medical specialists. Their demographic profiles are also similar, as well as their movements from 2019 to 2020. Anaesthetists and dental specialists have significantly lower numbers than medical and surgical specialists (60% lower). Their demographic profiles and the movements are similar to those of medical specialists.

In respect of pathology and radiology, there was growth in the number of HSPPs across all countries from 2019 to 2020. These numbers of HSPPs increased even on a per million population basis. Both Namibia and South Africa experienced increases from 2019 to 2020. In these two disciplines, Namibia had fewer new registrations in 2020 than in 2019 while South Africa had more de-registrations in 2020 than in 2019.

Annexure 1 lists the disciplines and how these have been classified for the purposes of this report. The detailed results at discipline level may be found on the BHF Live portal. The link to this portal is https://www.bhfportal.co.za/bhfglobal/

Copyright 2022 © Board of Healthcare Funders

5

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

1.1 The Practice Code Numbering System Each practice code number is a unique number assigned to a HSPP. The PCNS is the list of unique practice codes for HSPPs in Lesotho, Namibia, South Africa, and Zimbabwe. It provides a uniform and national identifier for billing and payments in the private sector.

1.2.1

South Africa

In South Africa, the Board of Healthcare Funders (BHF) administers the issuing of the unique practice number and maintains the PCNS database. When issuing practice numbers, the PCNS is bound by legislation and regulations from several entities. These include the National Department of Health’s guidelines, the nine provincial health departments and the several councils that have regulatory oversight of HSPPs.

1.2.2

Namibia

The Namibia Association of Medical Aid Funds (NAMAF), a statutory body, has mandated the PCNS to issue practice numbers for HSPPs in Namibia. NAMAF is responsible for setting up guides in terms of the disciplines and sub-disciplines in line with Namibian regulations. NAMAF is also responsible for managing the HSPPs’ application process, further to which the PCNS provide the unique practice numbers.

1.2.3

Lesotho

In Lesotho, there is a standard process for issuing practice numbers to avoid fragmentation. When a HSPP in Lesotho needs a practice number they approach Mamoth, a health funder in Lesotho, with an application. Mamoth assesses the information on each application and ensures compliance with Lesotho’s legislation. Once they are satisfied with the application it is passed on to the PCNS for the issuing of a number. The PCNS is used by all health funders in Lesotho.

Copyright 2022 © Board of Healthcare Funders

6

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

1.2.4

Zimbabwe

Zimbabwe has two mechanisms in place to enable and facilitate payments between health funders and health care providers 

CIMAS manages and issues BHF PCNS numbers to facilitate payments within their business.



The Association of Health Funders Zimbabwe (AHFoZ) an industry body for health funders, manages and issues the AHFoZ numbers that facilitate payments between AHFoZ members and healthcare professionals.

There is no formal relationship between AHFoZ and PCNS.

1.2.5

Botswana

The Health Funders Association Botswana (HFAB) has mandated the PCNS to issue practice numbers for HSPPs in Botswana. This process is ongoing and is close to completion. HFAB will be responsible for setting up guides in terms of the disciplines and sub-disciplines in line with Botswana’s regulations. HFAB will also be responsible for managing the application process.

Copyright 2022 © Board of Healthcare Funders

7

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

1.2 The Importance of the PCNS The PCNS offers a standardised way to identify and store details of practices/practitioners. The benefits of having a system to identify healthcare practitioners are immense. Firstly, from a planning perspective it’s important to know how many healthcare workers are available, their geographic location and respective disciplines and sub-disciplines. Planning includes public health initiatives by governments, the World Health Organization (WHO) and donor agencies. From a private health perspective, it’s important for funders to understand the supply of healthcare workers and to design benefits that deliver optimal healthcare for their members.

1.3.1 Human resources for health The PCNS is an important tool for monitoring HRH in any country or even regionally. This must be augmented by other databases of HRH as not all HSPPs may be registered on the PCNS database.

The World Health Report Global Strategy on Human Resources for Health: Workforce 2030 listed 57 countries (Lesotho and Zimbabwe included) that are facing a shortage of HRH (WHO, 2006). Of these 57 countries, 36 (63%) are in Africa. Africa has 2.3 healthcare workers per 1 000 population, compared with the Americas, which have 24.8 healthcare workers per 1 000 population (Naicker et al, 2009). An assessment of HRH in South Africa notes that HRH strategy should not merely focus on the number of personnel; the problem is broader, including uneven geographic and sector distribution (public vs private sector), shortages among disciplines and attrition of the workforce (George et al, 2012). More recently, it was noted that South Africa is among the top five countries in Africa in terms of density of primary care per 1 000 population (Rispel et al, 2018). However, there is a shortage of healthcare workers in the public sector and rural areas.

Human resource availability is important for achieving universal health coverage (UHC). A key component of this is good health outcomes. Speybroeck et al, 2006, and Anand & Bärnighausen 2007, concluded that there is a positive correlation between number of healthcare providers and population health outcomes.

Copyright 2022 © Board of Healthcare Funders

8

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

1.3.2 Mitigation of healthcare fraud waste and abuse In South Africa, all HSPPs need to have a practice number to be identifiable and submit claims to medical schemes in private healthcare. Without a practice number, a HSPP cannot be reimbursed by medical schemes. The practice number assures schemes that due diligence has been done by the PCNS department and this therefore minimises the number of fraudulent providers.

Healthcare fraud, waste and abuse (FWA) is an international problem affecting both developed and developing countries. Losses due to FWA are huge and occur more often in areas where there are fewer systems to mitigate such losses. The ability to uniquely identity a HSPP and match them to their geographic location and discipline goes a long way towards mitigating FWA. The ability to verify the fitness of a HSPP on an ongoing basis is a further benefit that ensures that only appropriately registered practitioners provide the relevant services to members of the public.

While the PCNS is a great tool for the mitigation of FWA, it should be noted that more needs to be done to reduce this scourge. The PCNS is not designed to fight FWA so stakeholders in the healthcare industry need to adopt additional measures to complement the PCNS. There must be platforms for collaboration to share data and identify and respond to FWA. The BHF has such a platform – the Health Forensic Management Unit (HFMU).

1.3.3 Standardisation and centralisation of HSPP information Health funders need to identify who is providing a service, and in places where there is no centralised numbering system funders tend to have their own processes for registering HSPPs. This creates a situation where HSPPs need to register with multiple funders. Such registration tends to be fragmented as each funder has different requirements. The processing of claims by the HSPP is further complicated as claims to each funder must be accompanied by the unique information provided while registering with that specific funder.

During registration HSPPs may end up with different unique identifiers for each funder. In some instances, they may provide different information while registering. This creates challenges for the industry as the exact number of providers available is unknown; collaboration on FWA is therefore hindered as HSPPs are not uniquely identified across all funders.

Furthermore, should any HSPP who is registered with several funders want to change or update their details, they would have to inform all the funders. With a system like the PCNS, there would be one point for applications and updates. The issue of updates is key; in the absence of a centralised system of practice number registration, it is highly unlikely that there would be an annual process by each funder to verify the status of each practice on an ongoing basis. The advantage of a centralised system is that it allows for regular updates to verify the status of practices.

Copyright 2022 © Board of Healthcare Funders

9

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

In the study we used a descriptive cross-section analysis. The study population of this report comprised HSPPs registered on the PCNS from 2019 to 2020. The data were solely quantitative and were analysed using STATA 15.1. The national population data for South Africa came from Statistics South Africa. For the populations of Lesotho, Namibia and Zimbabwe, the data source was Worldometer.

Annexure 1 lists the disciplines and how they have been classified for purposes of this report. The detailed results at the discipline level may be found on the BHF Live portal. The link for this portal is https://www.bhfportal.co.za/bhfglobal/

The PCNS number is useful for HSPPs to claim from medical schemes and other health funders. There are some HSPPs who do not need to claim from medical schemes. They do not need to be registered on the PCNS database; therefore the actual number of available healthcare workers/ HSPPs is unknown.

Furthermore, some HSPPs may maintain or renew their PCNS number while not practising. Some may even have emigrated to other countries. Therefore, the actual number of HSPPs providing services in the respective countries is not known with certainty.

The report covers a period where the world was facing the COVID-19 pandemic. The pandemic might have affected the number of HSPP registrations. The PCNS department does not record the reason for deregistration of a HSPP. In Lesotho, Namibia and Zimbabwe, the demographic data were incomplete and therefore some results would have been misleading. For instance, in some instances the gender of an HSPP was not recorded.

Copyright 2022 © Board of Healthcare Funders

10

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

4.1 HSPP disciplines by country This section summarises the distribution of active HSPPs in each country by discipline. There is also a brief overview of their demographic profiles.

4.1.1 South Africa There were 69 538 active HSPPs in South Africa in 2020. Most of them (56%) were SAHPs. FPs constituted 21% of active HSPPs followed by medical specialists at 7%. Radiology, pathology and medical technology had very low proportions; altogether they contribute less than 3% of HSPPs. Figure 1 shows the distribution of active HSPPs by discipline in 2020.

Figure 1: Distribution of active HSPPs by discipline in 2020

Copyright 2022 © Board of Healthcare Funders

11

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

The average age of the active HSPPs was 47.2 years in 2020, up from 46.8 years in 2019. Figure 2 shows the average age of HSPPs by discipline in 2020.

Figure 2: Average age of HSPPs by discipline in 2020

Active FPs, anaesthetists, pathologists, medical specialists and surgical specialists had an average age above 50 years while SAHPs had the lowest average age among active HSPPs. The dental disciplines had the lowest average age of registering HSPPs, 29.9 years for dentists and 29.2 years for dental specialists. Deregistering surgical specialists, anaesthetists and radiologists had an average age above 60 years.

Copyright 2022 © Board of Healthcare Funders

12

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

4.1.2 Namibia There were 2 048 active HSPPs in Namibia in 2020, up from 1 996 in 2019. Most of them (43%) were SAHPs. FPs constituted 29% of the active HSPPs followed by medical specialists at 7%. Figure 3 shows the distribution of active HSPPs by discipline in 2020.

Figure 3: Distribution of active HSPPs by discipline in 2020

Copyright 2022 © Board of Healthcare Funders

13

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

The average age of the active HSPPs was 45.4 years in 2020, up from 44.8 years in 2019. Figure 4 shows the average age of HSPPs by discipline in 2020.

Figure 4: Average age of HSPPs by discipline in 2020

Active FPs, medical specialists, anaesthetists and surgical specialists had an average age above 47 years while Medical Technologists had the lowest average age among active HSPPs at 41.1 years. The dentists had the lowest average age of registering HSPPs, 27.5 years, closely followed by radiologists at 29.3 years.

De-registering dentists and medical specialists had an average age above 50 years.

Copyright 2022 © Board of Healthcare Funders

14

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

4.1.3 Zimbabwe There were 2 882 active HSPPs in Zimbabwe in 2020. Most of them (45%) were SAHPs. FPs constituted 20% of the active HSPPs followed by medical specialists at 10%. Figure 5 shows the distribution of active HSPPs by discipline in 2020.

Figure 5: Distribution of active HSPPs by discipline in 2020

Copyright 2022 © Board of Healthcare Funders

15

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

The average age of the active HSPPs was 38.6 years in 2020, closely matched with 38.5 years in 2019. Figure 6 shows the average age of HSPPs by discipline in 2020.

Figure 6: Average age of HSPPs by discipline in 2020

There were no de-registrations of HSPPs recorded over the two-year period in Zimbabwe. The average age of active HSPPs is very similar to the average age of registering HSPPs.

Copyright 2022 © Board of Healthcare Funders

16

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

4.1.4 Lesotho There were 233 active HSPPs in Lesotho in 2020. Most of them (44%) were SAHPs. FPs constituted 33% of active HSPPs followed by both medical and surgical specialists, each at 5%. Dentists constituted 8% of active HSPPs. Figure 7 shows the distribution of active HSPPs by discipline in 2020.

Figure 7: Distribution of active HSPPs by discipline in 2020

Copyright 2022 © Board of Healthcare Funders

17

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

The average age of active HSPPs was 46.6 years in 2020, slightly up from 46.0 years in 2019. Figure 8 shows the average age of HSPPs by discipline in 2020.

Figure 8: Average age of HSPPs by discipline in 2020

Not many de-registrations were recorded over the two-year period in Lesotho. The average age of active HSPPs is very similar to that of registering HSPPs – in some instances higher.

Copyright 2022 © Board of Healthcare Funders

18

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

4.2 HSPPs’ demographic profile by country 4.2.1 Active HSPPs per country Table 1 shows the number of active HSPPs by country in 2019 and 2020. South Africa had the most, with more than 69 000 HSPPs across all disciplines in 2020. Lesotho had only 233 HSPPs in 2020. The number of HSPPs grew by 8.9% in Lesotho, the highest growth, while in Namibia this figure was 2.6%.

ACTIVE HSPPS

HSPPS PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

214

233

8.9%

100.69

108.76

8.0%

Namibia

1 996

2 048

2.6%

800.15

806.01

0.7%

Zimbabwe

2 749

2 882

4.8%

187.70

193.91

3.3%

South Africa

66 745

69 538

4.2%

1 135.60

1 166.31

2.7%

Table 1: Active HSPPs per country in 2019 and 2020

In terms of proportion of HSPPs per million population, South Africa had a density of 1 166 per million population in 2020, followed by Namibia with 806 per million population. Lesotho had the lowest density: 109 per million population in 2020. Lesotho experienced the highest growth in density of HSPPs per million population: 8% from 2019 to 2020.

Copyright 2022 © Board of Healthcare Funders

19

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

4.2.2 Movement of HSPPs per country Table 2 shows the movement of HSPPs by country in 2019 and 2020. There were no changes in the numbers of HSPPs registering in Lesotho from 2019 to 2020; the figure was 19 in both years. During the same period Namibia experienced a decline of 1% in the number of registering HSPPs, while both Zimbabwe and South Africa had declines of 24% and 18%, respectively.

MOVEMENT OF HSPPS Registration

Deregistration

2019

2020

% Change

2019

2020

% Change

Lesotho

19

19

0.0%

-

1

-

Namibia

201

200

-0.5%

149

155

4.0%

Zimbabwe

159

121

-23.9%

0

2

-

3 906

3 187

-18.4%

394

1 009

156.1%

South Africa

Table 2: Movement of HSPPs per country in 2019 and 2020

South Africa experienced a sharp increase in the number of HSPPs de-registering; from 394 in 2019 to 1 009 in 2020. Zimbabwe and Lesotho saw almost no de-registrations during the two-year period. In Namibia de-registrations grew by 4%, from 149 in 2019 to 155 in 2020.

Copyright 2022 © Board of Healthcare Funders

20

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

4.2.3 Demographic profiles of active HSPPs per country Table 3 shows the demographic profiles of active HSPPs by country in 2019 and 2020. Zimbabwe had the youngest population of HSPPs: their average age was 38.6 years in 2020. In other countries, the average ages were closer together, ranging from 45.4 years in Namibia to 47.2 years in South Africa.

AVERAGE AGE OF ACTIVE HSPPS (YEARS) 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

46.7

45.7

46.0

47.0

46.5

46.6

Namibia

43.4

46.2

44.8

44.0

46.7

45.4

Zimbabwe

40.8

37.1

38.5

38.8

37.5

38.6

South Africa

43.8

50.7

46.8

44.2

51.1

47.2

Table 3: Demographic profiles of active HSPPs per country

All the countries experienced an increase in the average age of active HSPP from 2019 to 2020.

Copyright 2022 © Board of Healthcare Funders

21

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

4.2.4 Demographic profiles of HSPPs registering per country Table 4 shows the demographic profiles of HSPPs registering by country in 2019 and 2020. The average age at registration is an important metric to monitor. This may suggest where the HSPPs are coming from; lower average ages suggest a significant portion of HSPPs are university graduates while higher average ages may suggest inward migration or seasoned HSPPs joining private practices after leaving public practice.

AVERAGE AGE OF HSPPS REGISTERING (YEARS) 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

45.0

42.1

42.9

45.3

41.2

43.7

Namibia

36.7

41.6

39.5

34.4

37.5

35.7

Zimbabwe

38.7

34.8

36.8

38.8

38.6

38.6

South Africa

35.5

37.1

36.0

34.8

37.0

35.5

Table 4: Demographic profiles of HSPPs registering per country

South Africa had the lowest average age of registering HSPPs, 35.5 years in 2020. Lesotho had the highest: 43.7 years in the same period.

Copyright 2022 © Board of Healthcare Funders

22

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

4.2.5 Demographic profiles of de-registered HSPPs per country Table 5 shows the demographic profiles of de-registered HSPPs per country in 2019 and 2020. The ages of HSPPs as they register are important to monitor; they may suggest the reason HSPPs are moving. An average age of de-registration closer to retirement age is preferable as this means the HSPPs serve their communities for longer. Very low average ages at de-registration may suggest outward migration, which is unfavourable.

AVERAGE AGE OF HSPPS DE-REGISTERING (YEARS) 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

38.0

38.0

Namibia

42.7

47.7

44.6

42.8

46.5

45.0

-

-

-

-

-

-

46.3

56.2

50.9

45.5

53.5

49.8

Zimbabwe South Africa

Table 5: Demographic profile of de-registered HSPPs per country

The average age of HSPPs de-registering increased in Namibia from 44.6 years in 2019 to 45 years in 2020.

In South Africa it fell from 50.9 years in 2019 to 49.8 years in 2020.

Copyright 2022 © Board of Healthcare Funders

23

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1 Primary healthcare service Primary healthcare providers act as a first point of contact and are often responsible for a patient’s overall well-being in respect of their healthcare requirements. These providers (medical and dental) are responsible for the coordination of any secondary healthcare that the patient may need. Such coordinated care is important for the sustainability of a health system. However, such coordinated care is not always achieved at schemes environment (Council for Medical Schemes, 2018).

5.1.1 Family practitioners 5.1.1.1 Active FPs per country Table 6 summarises the number of active FPs and the number of FPs per million population in each country from 2019 to 2020. The number of active FPs increased for all four countries from 2019 to 2020. Lesotho had the highest percentage increase, 13.4%, compared to other countries. FPs in Lesotho increased from 67 in 2019 to 76 in 2020. All four countries had more male than female FPs in both years.

ACTIVE FPs

FPs PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

67

76

13.4%

31.53

35.48

12.5%

Namibia

549

589

7.3%

220.08

231.81

5.3%

Zimbabwe

546

569

4.2%

37.28

38.28

2.7%

13 945

14 387

3.2%

237.26

241.30

1.7%

South Africa

Table 6: Number of active FPs per country in 2019 and 2020

The number of FPs per million population is highest in South Africa closely followed by Namibia. Lesotho had the highest increase of FPs per million population compared to other countries – 12.5%. In Namibia, FPs per million population increased by 5.3% from 220 in 2019 to 232 in 2020. The increase in FPs per million population for both South Africa and Zimbabwe was less than 3% over the same period.

Copyright 2022 © Board of Healthcare Funders

24

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.1.2

Movement of FPs per country

The number of FP registrations on the PCNS increased for all countries except South Africa, where it decreased from 601 in 2019 to 491 in 2020. Lesotho had the highest percentage increase in FP registrations from 2019 to 2020. The change in de-registration of FPs was highest in South Africa followed

by Namibia in 2019 and 2020. Table 7 highlights the movement of FPs per country.

MOVEMENT OF FPs Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

2

9

350.0%

0

0

-

Namibia

58

62

6.9%

22

41

86.4%

Zimbabwe

21

23

9.5%

0

0

-

South Africa

601

491

-18.3%

49

336

585.7%

Table 7: Movement of FPs per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

25

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.1.3

Demographic profiles of active FPs per country

The average age of active FPs increased slightly from 2019 to 2020 for all countries except Lesotho, where it remained unchanged. South Africa had the highest average age of active FPs in 2020: 50.6 years. This was followed by Namibia with an average age of 47.4 years. Zimbabwe had the lowest average age of active FPs compared to the other countries.

In Zimbabwe and Lesotho, female FPs are older than their male counterparts, while in Namibia and South Africa male FPs have a higher average age. Table 8 shows the average age of active FPs per country in 2019 and 2020.

AVERAGE AGE OF ACTIVE FPs (YEARS) 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

47.8

45.7

46.2

47.5

46.0

46.2

Namibia

45.4

47.8

47.1

45.7

48.1

47.4

Zimbabwe

43.3

39.1

40.1

48.3

38.9

40.9

South Africa

45.2

53.3

50.2

45.5

53.8

50.6

Table 8: Demographic profiles of active FPs per country in 2019 and 2020

5.1.1.4 Demographic profiles of FPs registering per country As expected, the average age of registering providers is lower than the average age of active FPs for all four countries. The average age of female FPs registering on the PCNS was lower than that of male FPs across all countries except Zimbabwe in 2020. Table 9 highlights the average age of FPs registering per country in 2019 and 2020.

AVERAGE AGE OF FPs REGISTERING (YEARS) 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

40.0

40.0

34.0

42.0

40.7

Namibia

38.7

43.0

41.8

34.9

41.1

37.9

Zimbabwe

34.0

32.0

33.0

51.3

38.2

40.7

South Africa

33.8

37.3

35.2

33.1

36.6

34.7

Table 9: Average age of FPs registering per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

26

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.1.5 Demographic profiles of de-registered FPs per country Table 10 shows the average age of FPs de-registering by gender and per country in 2019 and 2020. The average age of FPs in Namibia who de-registered increased slightly from 48.7 years to 49.1 years in 2019 and 2020, respectively. This is positive as it indicates longer service while in practice. The increase is largely attributed to female FPs; their average age increased from 37.9 years in 2019 to 46.0 years in 2020.

In 2020, the average age of FPs de-registering in South Africa declined significantly from 58.7 years to 50.1 years: this could be related to the COVID-19 pandemic. The average age of male FPs who de-registered was higher than the average age of female FPs in Namibia and South Africa in both 2019 and 2020. The average age of female FPs de-registering was less than 47 years for both Namibia and South Africa in 2019 and 2020.

AVERAGE AGE OF FPs DE-REGISTERING (YEARS) 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

37.9

55.8

48.7

46.0

49.1

49.1

-

-

-

-

-

-

44.6

62.4

58.7

43.4

53.2

50.1

Zimbabwe South Africa

Table 10: Average age of de-registration by gender and per country

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.1.6

Active FPs in South Africa

Figure 9 shows the number of active South African FPs and their average age per province in 2020. The number of active FPs increased from 13 945 in 2019 to 14 387 in 2020, translating to a 3.2% increase.

6000

60

5000

50

4000

40

3000

30

2000

20

1000

10

Avgerage Age of Providers

Approximately, over 8 300 (>60%) of FPs were male in 2020.

No of Providers

-

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

27

Average Age Male

Figure 9: Number of active FPs and their average age per province in 2020

The average age of active FPs in South Africa was 50.2 in 2019 and 50.6 years in 2020, with male FPs consistently older than female FPs. The average age of male FPs was 53.3 years; for female FPs it was 45.5 years. The average age of female FPs was less than 50 years across all provinces. Limpopo had the lowest average age for both male and female FPs in 2019 and 2020.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.1.7

Registration of FPs

Figure 10 shows the average age of registration of FPs in 2020 by province. Approximately 490 FPs registered on the PCNS in 2020. More female FPs registered in 2020. Gauteng had the highest number of registrations while the Northern Cape had the lowest. This is consistent with the population in each province.

45 40

200

35 30

150

25 20

100

15 10

50

5 0

Avgerage Age of Providers

250

No of Providers

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

28

Average Age Male

Figure 10: Number of registrations and average age of FPs in 2020 per province

The average age of FPs registering is lower compared to the average age of active FPs – 34.7 years in 2020.

Male FPs registering had an average age of 36.6 while females had an average age of 33.1 years. Similar trends were observed in 2019.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.1.8

De-registration of FPs

The number of FPs de-registering was 49 in 2019 and 336 in 2020. The high number of de-registrations in 2020 may be a concern. All provinces had FPs de-registering in 2020, with the Northern Cape and Gauteng reporting the lowest and highest number of de-registrations, respectively in 2020. The average age of FPs who de-registered was 58.7 years in 2019 and 50.1 years in 2020. Figure 11 shows the average age at de-

70

70

60

60

50

50

40

40

30

30

20

20

10

10

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

Figure 11: De-registration of FPs by gender and age

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

Average Age Male

Avgerage Age of Providers

registration of FPs in 2020 by province.

No of Providers

29

30

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.1.9

FPs per million population per province

The average number of FPs per million population in South Africa increased from 237 in 2019 to 241 in 2020. The proportion of FPs per million population increased in all provinces from 2019 to 2020. Limpopo reported the highest increase of 6.2% compared to other provinces, while Mpumulanga reported the

No of FPs per million population

lowest increase (0.2%). Figure 12 illustrates the number of FPs per province from 2019 to 2020.

400 350 300 250 200 150 100 50

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

Figure 12: Number of FPs per million population per province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

31

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.2

General dental practitioners

5.1.2.1

Active dentists per country

The number of active dentists in all four countries increased from 2019 to 2020. The density per million population is very low compared to that of FPs. Zimbabwe had the lowest increase (2.5%) of active dentists.

Lesotho had the lowest density per million population – fewer than 10 in both 2019 and 2020. Table 11 summarises the number of active dentists and number of dentists per million population per country from 2019 to 2020.

ACTIVE DENTISTS

DENTISTS PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

17

18

5.9%

8.00

8.40

5.0%

Namibia

129

133

3.1%

51.71

52.34

1.1%

Zimbabwe

198

203

2.5%

13.52

13.66

1.3%

3 844

3 955

2.9%

65.40

66.33

1.9%

South Africa

Table 11: Number of active dentists per country in 2019 and 2020

The density per million population is highest in South Africa, followed by Namibia – the same was observed with regard to FPs. Lesotho saw the highest increase of dentists per million population compared to the other countries at 5%. The increase in dentists per million population in South Africa was only 1.9%, while it was lowest in Namibia at 1.1%.

Copyright 2022 © Board of Healthcare Funders

32

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.2.2

Movement of dentists per country

Table 12 highlights the movement of dentists in each of the countries. The number of dentists registering decreased from 2019 to 2020 in all countries except Lesotho, where it remained unchanged. Zimbabwe experienced the biggest decrease in dentists registering from 2019 to 2020. The number of dentists deregistering in Namibia increased from three in 2019 to eight in 2020.

MOVEMENT OF DENTISTS Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

1

1

0.0%

0

0

-

Namibia

9

7

-22.2%

3

8

166.7%

Zimbabwe

12

5

-58.3%

0

0

-

South Africa

155

138

-11.0%

27

66

144.4%

Table 12: Movement of dentists per country in 2019 and 2020

5.1.2.3

Demographic profiles of active dentists per country

Table 13 shows the average age of dentists who had active practice numbers in 2019 and 2020. All countries experienced a slight increase in the average age of active dentists, except for Zimbabwe. In Zimbabwe, the average age of active dentists decreased from 39 years in 2019 to 33 years in 2020. In 2020, active female dentists had a lower average age than active male dentists in all the countries except Zimbabwe.

AVERAGE AGE OF ACTIVE DENTISTS (YEARS) 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

42.5

49.6

47.6

43.5

53.2

50.8

Namibia

42.4

44.5

43.2

43.1

44.9

43.8

-

39.0

39.0

33.7

32.3

33.0

39.4

50.4

46.4

39.8

50.9

46.7

Zimbabwe South Africa

Table 13: Average age of dentists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

33

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.2.4

Demographic profiles of dentists registering per country

The average age of dentists registering in 2020 was less than 30 years in both Namibia and South Africa.

In Zimbabwe and South Africa, the average age of female dentists registering was higher than that of male dentists. Table 14 highlights the average age of dentists registering per country in 2019 and 2020.

AVERAGE AGE OF DENTISTS REGISTERING (YEARS) 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

43.0

43.0

-

66.0

66.0

Namibia

35.3

33.3

34.7

27.0

28.0

27.5

Zimbabwe

-

-

-

33.7

28.5

31.6

South Africa

29.6

28.9

29.3

29.9

29.7

29.9

Table 14: Average age of dentists registering in 2019 and 2020

5.1.2.5

Demographic profiles of de-registering dentists per country

The average age of dentists de-registering in Namibia and South Africa was the same: 52.3 years in 2020.

The average age of dentists who de-registered increased in Namibia from 48.5 years in 2019 to 52.3 years 2020. In South Africa, the average age of dentists who de-registered decreased from 53.7 years in 2019 to 52.3 years in 2020. Female dentists de-registered at a younger age than male dentists in both Namibia and South Africa in 2020. Table 15 shows the average age of dentists at de-registration by gender and per country in 2019 and 2020.

AVERAGE AGE OF DENTISTS DE-REGISTERING (YEARS) 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

-

48.5

48.5

51.8

53.5

52.3

Zimbabwe

-

-

-

-

-

-

South Africa

47.9

56.2

53.7

39.9

56.7

52.3

Table 15: Average age at de-registration by gender and per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.2.6

Active general dentists in South Africa

The number of dentists with active PCNS numbers in South Africa increased by 2.9% to 3 955 in 2020, from 3 844 in 2019. Gauteng and the Western Cape have over 55% of the dentists with active PCNS numbers in South Africa. Of the dentists active on the PCNS in South Africa, 62% were male in 2020. Figure 13 shows the number of active South African dentists and their average age per province in 2020.

1600

50

1200

40

1000 800

30

600

20

400

10

200 0

Avgerage Age of Providers

60

1400 No of Providers

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

34

Average Age Male

Figure 13: Number of active dentists and their average age per province in 2020

The average age of active dentists in South Africa increased slightly, from 46.4 years in 2019 to 46.7 years in 2020. The average age of active female dentists in South Africa was 39.8 years in 2020, while for males it was 50.9 years. Active dentists in North-West had the highest average age: 48.3 years in 2019 and 48.6 years in 2020. This was followed by the Eastern Cape with an average age of 48 years in 2020.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.2.7

REGISTRATION OF DENTISTS

Figure 14 shows the average age at registration of dentists in 2020 by province. One hundred and thirtyeight dentists registered on the PCNS in 2020. This is lower than the 155 dentists who registered in 2019.

Of the 138, 85 were female. It is worth noting that no female dentists registered in the Free State and

40 35 30 25 20 15 10 5 -

70 60 50 40 30 20 10

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

Avgerage Age of Providers

Northern Cape in 2020.

No of Providers

35

Average Age Male

Figure 14: Number of registrations and age of dentists in 2020 per province

The average age of dentists who registered in 2020 was 29.9 years. The average age of female dentists was slightly higher than that of males in 2020. Only Gauteng, Mpumalanga and North-West had an average age above 30 years at registration.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.2.8

De-registration of dentists

Figure 15 shows the average age at de-registration of dentists in 2020 by province. The number of dentists de-registering in South Africa was 27 in 2019, increasing to 66 in 2020. In both years, most of the deregistrations occurred in Gauteng, KwaZulu-Natal and the Western Cape. The average age of dentists who de-registered in 2020 was 52.3 years. The average age of de-registering male dentists (56.7 years) was higher than that of female dentists (39.9 years) in 2020. The high increase in de-registrations may have

12

70 60 50 40 30 20 10 -

10 8 6 4 2

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

Figure 15: De-registration of dentists by gender and age

Copyright 2022 © Board of Healthcare Funders

Average Age Male

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

Avgerage Age of Providers

been due to the restrictions imposed during the COVID-19 pandemic.

No of Providers

36

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.1.2.9

Dentists per million population

The proportion of dentists with active practice numbers on the PCNS per million population increased slightly from 65 in 2019 to 66 in 2020. The Western Cape had the highest density of dentists per million population in both years –over 100. Figure 16 shows the number of dentists per province from 2019 to 2020.

No of dentists per million population

140 120 100 80 60 40 20

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

37

Figure 16: Number of dentists per million population per province

The Eastern Cape, Limpopo and North-West had very low densities of dentists per million population - less than 40 in both 2019 and 2020.

Copyright 2022 © Board of Healthcare Funders

38

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2 Supplementary and allied health professionals 5.2.1

Allied professionals

5.2.1.1

Active SAHPs per country

Table 16 summarises the number of active SAHPs and SAHPs per million population for each country from 2019 to 2020. The number of active SAHPs and SAHP per million population grew across all countries, except Namibia. The active SAHP in Namibia decreased by 0.2% from 880 in 2019 to 878 in 2020.

ACTIVE SAHPs

SAHPs PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

96

103

7.3%

45.17

48.08

6.4%

Namibia

880

878

-0.2%

352.77

345.55

-2.1%

Zimbabwe

1 235

1 288

4.3%

84.33

86.66

2.8%

South Africa

36 916

38 882

5.3%

628.09

652.14

3.8%

Table 16: Number of SAHPs per country in 2019 and 2020

The number of active SAHPs per million population is highest in South Africa followed by Namibia – the same was observed with regard to FPs and dentists. Lesotho had the highest increase in SAHPs per million population compared to the other countries – 6.4%; it was followed by South Africa at 3.8%. The increase in SAHPs per million population in Zimbabwe was only 2.8%, while in Namibia it decreased by 2.1%.

Copyright 2022 © Board of Healthcare Funders

39

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.1.2

Movement of SAHPs per country

The number of SAHPs registering in Namibia increased by 12.3% to 82 in 2020, up from 73 in 2019. The other countries recorded a decline in the registration of SAHPs, with Lesotho having the highest decline of 22.2%. Table 17 shows the movement of SAHPs per country.

MOVEMENT OF SAHPs Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

9

7

-22.2%

0

1

-

Namibia

73

82

12.3%

84

64

-23.8%

Zimbabwe

57

53

-7.0%

0

0

-

South Africa

2 702

2 236

-17.2%

270

478

77.0%

Table 17: Movement of SAHPs per country in 2019 and 2020

5.2.1.3

Demographic profile of active SAHPs per country

The average age of active SAHPs in Zimbabwe was the lowest compared to the other countries for both 2019 and 2020. The average age of active SAHPs in Zimbabwe was 37.8 years in 2019, declining to 37.1 years in 2020. South Africa had the highest average age of active SAHPs – 44.2 years. Lesotho followed closely at 43.8 years in 2020. Table 18 highlights the average age of active SAHPs per country in 2019 and 2020.

AVERAGE AGE OF ACTIVE SAHPs 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

45.0

40.8

43.1

45.5

41.4

43.8

Namibia

42.1

41.4

41.9

42.7

41.3

42.3

Zimbabwe

42.2

34.9

37.8

37.6

36.8

37.1

South Africa

43.6

44.9

43.9

43.9

45.1

44.2

Table 18: Average age of SAHPs per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

40

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.1.4

Demographic profile of SAHPs registering per country

SAHPs registering in Lesotho had the highest average age – 41.2 years in 2020. Namibia had the lowest average age for registering SAHPs. It was 33.9 years in 2020 – lower than in 2019. The average age of male SAHPs registering in Lesotho and Namibia was lower than that of their female counterparts in 2020. Table 19 shows the average age of SAHPs registering per country in 2020.

AVERAGE AGE OF SAHPs REGISTERING 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

39.0

39.0

39.0

43.0

34.0

41.2

Namibia

35.8

32.5

35.5

35.3

31.0

33.9

-

34.7

34.7

34.8

37.4

36.1

35.5

34.4

35.2

34.6

34.9

34.7

Zimbabwe South Africa

Table 19: Average age of SAHPs registering in 2019 and 2020

5.2.1.5

Demographic profile of de-registered SAHPs per country

Table 20 shows the average age of de-registering SAHPs by gender and per country in 2019 and 2020. The average age of de-registering SAHPs in South Africa was highest compared to the other countries in both 2019 and 2020. The average age of SAHP de-registering in South Africa decreased from 48.2 years in 2019 to 46.3 in 2020. In Namibia and South Africa, female SAHPs who de-registered had a lower average age than their male counterparts in 2020.

AVERAGE AGE OF SAHPs DE-REGISTERING 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

38.0

38.0

Namibia

42.8

43.9

42.9

42.2

43.7

42.5

-

-

-

-

-

-

47.1

52.2

48.2

46.3

46.4

46.3

Zimbabwe South Africa

Table 20: Average age of de-registering SAHPs by gender and per country

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.1.6

Active SAHPs in South Africa

Figure 17 shows the number of active SAHPs and their demographic profiles per province in South Africa.

Active SAHPs in South Africa increased by 5.3% to 38 882 in 2020, up from 36 916 in 2019. This increase was highest in Limpopo at 8.3% from 2019 to 2020. Over 27 000 or approximately 70% of active SAHPs were females in 2020.

14000

50

12000

40

10000

30

8000 6000

20

4000

10

2000

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

Avgerage Age of Providers

60

16000

No of Providers

41

Average Age Male

Figure 17: Number of active SAHPs in 2020

In South Africa, the average age of active SAHPs increased slightly from 43.9 years in 2019 to 44.2 years in 2020. Active male SAHPs had a higher average age compared to active female SAHPs in both years. The line graph in Figure 17 illustrates that the average age of SAHPs is similar across all provinces.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.1.7

Registration of SAHPs

Figure 18 shows the number of registering SAHPs and their demographic profiles by province in South Africa. There were 2 236 SAHPs who registered on the PCNS in 2020. A higher proportion of SAHP females

1000 900 800 700 600 500 400 300 200 100 0

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

50 45 40 35 30 25 20 15 10 5 -

Avgerage Age of Providers

(78%) registered on the PCNS compared to SAHP males in every province in 2020.

No of Providers

42

Average Age Male

Figure 18: Number of registrations and age of SAHPs in 2020 per province

The average age of registering SAHPs was 34.7 years across South Africa in 2020. It was lower than the 35.2 years in 2019. Registering male SAHPs had a slightly higher average age than females in 2020, while in 2019 registering female SAHPs had the higher average age.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.1.8

De-registration of SAHPs

Figure 19 highlights the number of de-registering SAHPs and their demographic profiles by province in South Africa. There was a significant increase in the number of SAHPs de-registering between 2019 and 2020. There were 478 SAHPs who de-registered in 2020 compared to 270 in 2019. The average age of

80

120

70

100

60

80

50 40

60

30

40

20

20

10 -

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

Figure 19: De-registration of SAHPs by gender and age

Copyright 2022 © Board of Healthcare Funders

Average Age Male

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

Avgerage Age of Providers

SAHPs de-registering was 48.2 years in 2019, decreasing to 46.3 years in 2020.

No of Providers

43

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.1.9

SAHPs per million population

The density of active SAHPs per million population increased from 628 in 2019 to 652 in 2020. Gauteng and the Western Cape had a density of active SAHPs above 1 000 per million population in 2020. The Eastern Cape had the lowest proportion of SAHPs per million population in both 2019 and 2020: 297 per million population in 2020. Figure 20 shows the number of SAHPs per province from 2019 to 2020.

No of SAHP per million population

120 100 80 60 40 20

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

Figure 20: Number of SAHPs per million population per province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

44

45

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.2

Medical technologists

5.2.2.1

Active medical technologists per country

There were no active medical technologists in Lesotho from 2019 to 2020. Only South Africa and Zimbabwe experienced an increase in the number and density of medical technologists during this time. The number per million population was very low in South Africa and Zimbabwe (less than two), compared to Namibia, where it was 24. Table 21 summarises the number of active medical technologists and number of medical technologists per million population per country from 2019 to 2020.

ACTIVE MEDICAL TECHNOLOGYPRACTICES

MEDICAL TECHNOLOGY PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

-

-

-

-

-

-

Namibia

63

61

-3.2%

25.26

24.01

-4.9%

Zimbabwe

25

28

12.0%

1.71

1.88

9.9%

South Africa

103

118

14.6%

1.75

1.98

13.1%

Table 21: Number of medical technologists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

46

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.2.2

Movement of medical technologists per country

Table 22 shows the movement of medical technologists per country. Namibia had the highest increase in the number of medical technologists registering – 600% in 2020. South Africa had a more than 100% increase from 2019 to 2020. Zimbabwe saw a decline of 40% in the number of registrations over the same period. The number of medical technologists de-registering in Namibia declined from 16 in 2019 to 11 in 2020. This equates to a 31.3% decline.

MOVEMENT OF MEDICAL TECHNOLOGY PRACTICES Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

-

-

-

-

-

-

Namibia

2

14

600.0%

16

11

-31.3%

Zimbabwe

5

3

-40.0%

-

-

-

South Africa

7

16

128.6%

1

1

0.0%

Table 22: Movement of medical technologists registering in 2019 and 2020

5.2.2.3

Demographic profiles of active medical technologists per country

Table 23 highlights the average age of active medical technologists by country in 2019 and 2020. It decreased slightly from 2019 to 2020 in South Africa. Medical technologists in South Africa had the highest average age (49.3 years) compared to the other countries.

AVERAGE AGE OF ACTIVE MEDICAL TECHNOLOGISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

36.5

42.1

39.8

37.6

44.0

41.1

-

-

-

34.0

33.0

33.5

47.4

51.5

49.7

47.2

51.0

49.3

Zimbabwe South Africa

Table 23: Average age of medical technologists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

47

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.2.4

Demographic profiles of medical technologists registering per country

Table 24 shows the average age of medical technologists registering in 2019 and 2020. South Africa had the highest average age for medical technologists registering on the PCNS, compared to the other countries, in 2020.

AVERAGE AGE OF MEDICAL TECHNOLOGISTS REGISTERING 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

61.0

42.0

51.5

36.2

33.0

35.4

-

-

-

34.0

33.0

33.5

36.0

34.0

34.9

39.0

40.4

39.7

Zimbabwe South Africa

Table 24: Average age of medical technologists registering in 2019 and 2020

5.2.2.5

Average age of de-registering medical technologists per country

The average age of de-registering medical technologists in Namibia increased by 0.6 years from 2019 to 2020, while in South Africa it increased by four years. Table 25 shows the average age at de-registration by gender and per country in 2019 and 2020.

AVERAGE AGE OF MEDICAL TECHNOLOGISTS DE-REGISTERING 2019 Female

Male

2020 Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

35.0

35.3

35.2

31.4

40.2

35.8

-

-

-

-

-

-

33.0

-

33.0

-

37.0

37.0

Zimbabwe South Africa

Table 25: Average age at de-registration by gender and per country

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.2.6

Active medical technologists in South Africa

In South Africa, the number of active medical technologists in 2020 was 118, while in 2019 it was 103; this equates to a 14.6% increase. There were more male than female active medical technologists in both 2019 and 2020. During the two-year period, the Northern Cape had no active medical technologists. Figure 21

50

80

45

70

40

60

35 30

50

25

40

20

30

15

20

10

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

0 WESTERN CAPE

10 GAUTENG

5

Average Age Male

Figure 21: Number of active medical technologists in 2020

The average age of active medical technologists declined from 49.7 years in 2019 to 49.3 years in 2020.

The average age was highest in the Free State – over 65 years in both 2019 and 2020. It is a cause for concern that the average age of active medical technologists in the Free State is retirement age.

Copyright 2022 © Board of Healthcare Funders

Avgerage Age of Providers

illustrates the number and average age of active medical technologists in 2020.

No of Providers

48

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.2.7

Registration of medical technologists

Figure 22 shows the number and average age at registration of medical technologists in 2020 by province.

The number of registrations increased from seven in 2019 to 16 in 2020 across South Africa. Gauteng and KwaZulu-Natal had a total of five registrations in 2020. The Free State and Northern Cape had no

20

1

10

0

-

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

2

EASTERN CAPE

30

MPUMALANGA

3

NORTHERN CAPE

40

LIMPOPO

4

FREE STATE

50

KWAZULU-NATAL

5

WESTERN CAPE

60

GAUTENG

6

Avgerage Age of Providers

registrations that year.

No of Providers

49

Average Age Male

Figure 22: Number of registrations of medical technologists in 2020

The average age of registering medical technologists in 2019 and 2020 was 34.9 years and 39.7 years, respectively. This represents an increase of 4.8 years. Gauteng had the lowest average age of male medical technologists registering in 2020.

Copyright 2022 © Board of Healthcare Funders

50

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.2.2.8

De-registration of medical technologists

One medical technologist de-registered in 2019 and another in 2020. These de-registrations took place in KwaZulu-Natal and North-West, respectively.

5.2.2.9

Medical technologists per million population

Figure 23 illustrates the number of medical technologists per million population in South Africa in 2020.

The density was very low - fewer than two per million population in both years. Only Gauteng, KwaZuluNatal and Limpopo had a proportion higher than the average of 1.96 in 2020. The Eastern Cape and North-

4 3 3 2 2 1 1

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

Figure 23: Number of medical technologists per million population per province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

No of medical technologist per million population

West had proportions lower than one per million population in 2020.

51

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3 Specialists A specialist is defined as a HSPP who focuses on a specific area of medicine/group of patients to diagnose, manage, prevent or treat certain symptoms and conditions.

5.3.1

Anaesthetists

5.3.1.1

Active anaesthetists per country

Table 26 summarises the number of active anaesthetists and number of anaesthetists per million population by country from 2019 to 2020. The number of active anaesthetists was unchanged in Lesotho over the two-year period. The number of active anaesthetists in South Africa and Zimbabwe increased marginally between 2019 and 2020.

Lesotho had the lowest number of anaesthetists per million (0.47) population compared to the other countries in both 2019 and 2020. In Namibia, the density of anaesthetists per million population decreased from 14.43 in 2019 to 13.38 in 2020, which translates to a 7.3% decrease.

ACTIVE ANESTHETISTS

ANESTHETISTS PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

1

1

0.0%

0.47

0.47

0.0%

Namibia

36

34

-5.6%

14.43

13.38

-7.3%

Zimbabwe

67

69

3.0%

4.57

4.64

1.5%

1 532

1 558

1.7%

26.07

26.13

0.2%

South Africa

Table 26: Number of anesthetists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

52

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.1.2

Movement of anaesthetists

Namibia and Zimbabwe both had three anaesthetists registering in 2019. Only South Africa and Zimbabwe saw the registration of at least one anaesthetist in 2020 - 33 and two, respectively. In South Africa, the number of de-registering anaesthetists increased from seven in 2019 to 13 in 2020. Table 27 highlights the movement of anaesthetists per country.

MOVEMENT OF ANESTHETISTS Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

0

0

-

0

0

-

Namibia

3

0

-100%

2

2

0.0%

Zimbabwe

3

2

-33.3%

0

0

-

South Africa

44

33

-25.0%

7

13

85.7%

Table 27: Movement of anaesthetists per country in 2019 and 2020

5.3.1.3

Demographic profile of active anaesthetists per country

Table 28 shows the average age of active anaesthetists in each country in 2019 and 2020. The average age of active anaesthetists was over 50 years in all countries except Zimbabwe, where it was 36 years. The average ages of active female anaesthetists in Namibia and South Africa were lower compared to their male counterparts in both 2019 and 2020. All four countries saw an increase in the average age of active anaesthetists from 2019 to 2020.

AVERAGE AGE OF ACTIVE ANESTHETISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

61.0

61.0

-

62.0

62.0

Namibia

42.3

53.6

50.9

43.3

56.1

52.7

Zimbabwe

35.0

-

35.0

36.5

35.0

36.0

South Africa

45.8

53.3

50.4

46.1

54.1

51.0

Table 28: Average age of anaesthetists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

53

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.1.4

Average age of anaesthetists registering per country

Table 29 shows the average age of anaesthetists registering per country during the two-year period. In Zimbabwe it increased from 35 years in 2019 to 36 years in 2020. In South Africa, it decreased from 37.8 years in 2019 to 35.9 years in 2020. The average age of male anaesthetists registering was lower compared to female anaesthetists in both South Africa and Zimbabwe in 2020.

AVERAGE AGE OF REGISTERING ANAESTHETISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

38.0

36.0

36.7

-

-

-

Zimbabwe

35.0

-

35.0

37.0

35.0

36.0

South Africa

36.6

40.3

37.8

36.2

34.3

35.9

Table 29: Average age of anaesthetists registering in 2019 and 2020

5.3.1.5

Average age of de-registered anaesthetists per country

Table 30 shows the average age at de-registration by gender and per country in 2019 and 2020. Lesotho and Zimbabwe saw no anaesthetists de-registering during the two-year period. The average age at deregistration in South Africa is consistent with the age of retirement.

AVERAGE AGE OF DE-REGISTERING ANAESTHETISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

-

39.5

39.5

-

42.0

42.0

Zimbabwe

-

-

-

-

-

-

South Africa

72.0

60.8

62.4

54.0

70.5

63.4

Table 30: Average age at de-registration by gender and per country

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.1.6

Active anaesthetists in South Africa

Figure 24 illustrates the number of active anaesthetists and their demographic profiles in South Africa in 2020. The number of anaesthetists was 1 532 and 1 558 in 2019 and 2020, respectively. This translates to a 1.7% increase year on year. Over 85% of the active anaesthetists were resident in Gauteng, the Western

800

70

700

60

600

50

500

40

400

30

300

20

200

10

100

Avgerage Age of Providers

Cape and KwaZulu-Natal.

No of Providers

-

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

54

Average Age Male

Figure 24: Number of active anaesthetists per province

Figure 24 shows that male anaesthetists had a higher average age than female anaesthetists in 2020. The average age of an anaesthetist in South Africa was 51 years in 2020. This is slightly higher than the average age in 2019, which was 50.4 years. Limpopo had the highest average age of active anaesthetists compared to other provinces during the two-year period. The average age of anaesthetists in Limpopo was 57.1 years in 2019 and 58.1 years in 2020.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.1.7

Registration of anaesthetists

There was a total of 33 registrations in South Africa in 2020, of which 27 were female anaesthetists. Only four provinces had anaesthetists who registered on the PCNS in 2020. Figure 25 highlights the number

45 40 35 30 25 20 15 10 5 -

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

18 16 14 12 10 8 6 4 2 0

Avgerage Age of Providers

and average age in 2020 for each province.

No of Providers

55

Average Age Male

Figure 25: Number of registrations of anaesthetists in 2020

The average age of anaesthetists registering was 35.9 years in 2020. Female anaesthetists were older than male anaesthetists by 1.9 years (36.2 years vs 34.3 years) in 2020. Gauteng had the lowest average age at registration compared to other provinces in 2020 – 35.7 years.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.1.8

De-registration of anaesthetists

The number of anaesthetists de-registering from the PCNS in South Africa increased to 13 in 2020, up from seven in 2019. Gauteng accounted for over 50% of de-registrations in both 2019 and 2020. The average age of anaesthetists de-registering increased from 62.4 years in 2019 to 63.4 years in 2020. Figure 26

3.5

100 90 80 70 60 50 40 30 20 10 -

3 2.5 2 1.5 1 0.5

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

Figure 26: De-registration of anaesthetists by province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

Average Age Male

Avgerage Age of Providers

shows the number and average age of anaesthetists de-registering in 2020 by province.

No of Providers

56

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.1.9

Anaesthetists per million population

The number of anaesthetists per million population in South Africa was approximately 26 in 2019 and 2020.

It was higher in the Western Cape in 2019 and 2020, remaining above 55 during the two-year period.

Limpopo had the lowest number of anaesthetists per million population in the same period. Figure 27 shows the number of anaesthetists per province from 2019 to 2020.

70 60 50 40 30 20 10

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

Figure 27: Number of anaesthetists per million population per province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

No of anaesthetists per million population

57

58

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.2

Dental specialists

5.3.2.1

Active dental specialists per country

The number of active dental specialists increased in Namibia and South Africa from 2019 to 2020, while it remained unchanged in Lesotho and Zimbabwe. In Namibia, the number of dental specialists grew by 4.3% from 2019 to 2020, while the proportion per million population grew by 2.4%. South Africa had the highest number of dental specialists per million population in both 2019 (23.33) and 2020 (23.65).

Lesotho had a very low number of dental specialists per million population – less than one during the twoyear period. Table 31 summarises the number of active dental specialists and number of dental specialists per million population per country from 2019 to 2020.

ACTIVE DENTAL SPECIALISTS

DENTAL SPECIALISTS PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

2

2

0.0%

0.94

0.93

-1.1%

Namibia

46

48

4.3%

18.44

18.89

2.4%

Zimbabwe

18

18

0.0%

1.23

1.21

-1.63%

1 371

1 410

2.8%

23.33

23.65

1.4%

South Africa

Table 31: Number of dental specialists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

59

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.2.2

Movement of dental specialists

Table 32 shows the movement of dental specialists by country. Namibia had the same number of dental specialists registering (five) in 2019 and 2020. In Zimbabwe, only one dental specialist registered over the two-year period.

The number of dental specialists de-registering in Namibia increased from three to four from 2019 to 2020, while in South Africa it declined from 13 to five. No dental specialists de-registered in Lesotho and Zimbabwe.

MOVEMENT OF DENTAL SPECIALISTS Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

-

-

-

-

-

-

Namibia

5

5

0.0%

3

4

33.3%

Zimbabwe

1

-

-100%

-

-

-

South Africa

54

52

-3.7%

13

5

-61.5%

Table 32: Movement of dental specialists per country in 2019 and 2020

5.3.2.3

Demographic profile of active dental specialists per country

Table 33 shows the average age of dental specialists by country in 2019 and 2020. The average age of active dental specialists increased in Lesotho, Namibia and South Africa. No data were available for Zimbabwe.

AVERAGE AGE OF ACTIVE DENTAL SPECIALISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

51.0

51.0

-

52.0

52.0

Namibia

47.4

41.9

43.2

47.5

42.0

43.4

-

-

-

-

-

-

38.1

49.6

46.3

38.2

49.9

46.4

Zimbabwe South Africa

Table 33: Average age of dental specialists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

60

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.2.4

Average age of dental specialists registering per country

The average age of dental specialists registering in South Africa was less than 30 in both 2019 and 2020.

The average age in Namibia was 35.3 years in 2020, down from 37.8 years in 2019. Table 34 highlights the average age of dental specialists registering per country in 2019 and 2020.

AVERAGE AGE OF REGISTERING DENTAL SPECIALISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

34.0

38.8

37.8

39.0

33.5

35.3

Zimbabwe

-

-

-

-

-

-

South Africa

26.8

33.2

29.8

26.8

31.8

29.2

Table 34: Average age of dental specialists registering per country in 2019 and 2020

Male dental specialists registering in South Africa had a significantly higher average age than females in both 2019 and 2020. Female dental specialists registering in Namibia had a higher average age than male dental specialists registering in 2020.

5.3.2.5

Average age of de-registering dental specialists per country

Table 35 shows the average age of de-registering dental specialists by gender and country in 2019 and 2020. The average age of de-registering dental specialists was highest in Namibia (44.3 years) and lowest in South Africa (35.3 years) in 2020.

AVERAGE AGE OF DE-REGISTERING DENTAL SPECIALISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

-

44.3

44.3

63.0

35.0

44.3

Zimbabwe

-

-

-

-

-

-

South Africa

41.0

54.2

52.0

23.0

41.5

35.3

Table 35: Average age at de-registration by gender and per country

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.2.6

Active dental specialists in South Africa

Figure 28 highlights the number and demographic profiles of active dental specialists in 2020 in South Africa. The number of active dental specialists in South Africa increased from 1 371 in 2019 to 1 410 in 2020. This translates to a 2.8% increase. There were more male dental specialists than females in both years. Gauteng, the Western Cape and KwaZulu-Natal were the only provinces with over 100 active dental specialists over the two-year period.

500

60 50

400 350

40

300 250

30

200 20

150 100

10

Avgerage Age of Providers

450

No of Providers

50 -

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

61

Average Age Male

Figure 28: Number of active dental specialists

The average age of active dental specialists in South Africa was 46.3 years in 2019 and 46.4 years in 2020.

The graph further shows that males were on average older than females across all provinces.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.2.7

Registration of dental specialists

The number of dental specialists who registered in South Africa in 2019 and 2020 was 54 and 52, respectively. KwaZulu-Natal recorded the highest number of registrations compared to other provinces in both years. Figure 29 shows the number and demographic profiles of registering dental specialists in 2020

25

8

20

6

15

4

10

2

5

0

-

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

10

EASTERN CAPE

30

MPUMALANGA

12

NORTHERN CAPE

35

LIMPOPO

14

FREE STATE

40

KWAZULU-NATAL

16

WESTERN CAPE

45

GAUTENG

18

Avgerage Age of Providers

by province

No of Providers

62

Average Age Male

Figure 29: Number of registrations of dental specialists in 2020

The average age of dental specialists registering on the PCNS in 2020 was 29.2 years. In 2019, the average age was 29.8 years. Male dental specialists had an average age of 31.8 years in 2020 (as opposed to 33.2 years in 2019) while female dental specialists had an average age of 26.8 years in 2020 (unchanged from 2019).

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.2.8

De-registration of dental specialists

The number of dental specialists who de-registered in South Africa was 13 and five in 2019 and 2020, respectively. In the same period, more male dental specialists de-registered. The average age of dental specialists who de-registered decreased significantly from 52 years in 2019 to 35.3 years in 2020. Figure

4

120 100

3

80 60

2

40

1

20 -

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

Figure 30: De-registration of dental specialists by gender and age

Copyright 2022 © Board of Healthcare Funders

Average Age Male

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

Avgerage Age of Providers

30 highlights the number and demographic profiles of de-registering dental specialists in 2020 by province.

No of Providers

63

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.2.9

Dental specialists per million population

In South Africa, the number of dental specialists per million population was 24 in 2020. This represents an increase from the 23 per million population in 2019. Gauteng had the highest number of dental specialists per million population compared to other provinces. The number of dental specialists per million population in Gauteng was 37 in 2019 and 39 in 2020. The number of dental specialists per million population in Limpopo and the Eastern Cape remained unchanged between 2019 and 2020: 14 and seven, respectively. Figure 31 shows the number of active dental specialists per million population in 2020.

120 100 80 60 40 20

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

Figure 31: Number of dental specialists per million population per province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

No of dental specialists per million population

64

65

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.3

Medical specialists

5.3.3.1

Active medical specialists per country

The number of active medical specialists grew in all four countries, with Zimbabwe having the highest increase: 11.5% from 2019 to 2020. Similarly, the number of medical specialists per million population increased across all four countries, with South Africa recording the lowest increase of 0.3%. Table 36 shows the number of medical specialists per country in 2019 and 2020.

ACTIVE MEDICAL SPECIALISTS

ACTIVE MEDICAL SPECIALISTS PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

10

11

10.0%

4.71

5.13

8.9%

Namibia

127

140

10.2%

50.91

55.10

8.2%

Zimbabwe

261

291

11.5%

17.82

19.58

9.9%

4 694

4 777

1.8%

79.86

80.12

0.3%

South Africa

Table 36: Number of medical specialists per country in 2019 and 2020

Zimbabwe saw the highest growth of active medical specialists per million population: 9.9% from 17.82 in 2019 to 19.58 in 2020. Lesotho had only 5.13 medical specialists per million population, while South Africa enjoyed 80.12 medical specialists per million population.

Copyright 2022 © Board of Healthcare Funders

66

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.3.2

Movement of medical specialists per country

Table 37 highlights the movement of medical specialists per country from 2019 to 2020. The number of medical specialists registering in all countries declined significantly from 2019 to 2020. Namibia experienced the least decline (38.5%) compared to other countries.

MOVEMENT OF MEDICAL SPECIALISTS Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

3

1

-66.7%

-

-

-

Namibia

26

16

-38.5%

3

11

266.7%

Zimbabwe

36

18

-50%

-

-

-

South Africa

162

98

-39.5%

15

68

353.3%

Table 37: Movement of medical specialists per country in 2019 and 2020

Lesotho and Zimbabwe saw no medical specialists de-registering in both 2019 and 2020. Both South Africa and Namibia experienced large increases in de-registration, however. In Namibia, the number of deregistering medical specialists increased from three in 2019 to 11 in 2020, while in South Africa it increased from 15 in 2019 to 68 in 2020.

Copyright 2022 © Board of Healthcare Funders

67

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.3.3

Demographic profiles of active medical specialists per country

The average age of active medical specialists increased over the period in all the countries. Zimbabwe had the lowest average age of 39.7 years in 2020. In Lesotho, the average age was significantly higher at 51.6 years in 2020. Table 38 shows the average age of active medical specialists by country in 2019 and 2020.

AVERAGE AGE OF ACTIVE MEDICAL SPECIALISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

53.0

47.3

50.6

54.0

48.3

51.6

Namibia

49.0

46.6

48.3

48.3

47.6

48.5

Zimbabwe

38.3

39.7

39.0

37.8

40.4

39.7

South Africa

46.0

55.0

51.3

46.7

55.7

52.0

Table 38: Average age of active medical specialists per country in 2019 and 2020

5.3.3.4

Average age of medical specialists registering per country

South Africa and Namibia recorded a decline in the average age of medical specialists registering on the PCNS from 2019 to 2020, while Zimbabwe experienced an increase. The average age of male medical specialists registering in both Namibia and Zimbabwe was higher than that of their female counterparts in 2020. Table 39 highlights the average age of medical specialists registering per country in 2019 and 2020.

AVERAGE AGE OF REGISTERING MEDICAL SPECIALISTS

2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

42.0

38.5

39.7

-

-

-

Namibia

38.4

47.1

44.3

35.6

49.0

37.8

Zimbabwe

38.3

37.5

38.0

36.3

40.3

39.6

South Africa

37.4

37.9

37.6

38.2

35.8

37.2

Table 39: Average age of medical specialists registering per country in 2019 and 2020

The average age of male medical specialists registering in Namibia was higher than that of active male medical specialists in 2020. It is not a normal scenario for the average age of HSP registering to be higher than the average age of active HSP.

Copyright 2022 © Board of Healthcare Funders

68

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.3.5

Average age of de-registering medical specialists per country

Table 40 shows the average age of de-registering medical specialists by gender and country. The average age of de-registering medical specialists declined from 2019 to 2020 in both Namibia and South Africa.

AVERAGE AGE OF DE-REGISTERING MEDICAL SPECIALISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

53.0

-

60.5

52.0

51.1

53.3

-

-

-

-

-

-

58.7

64.9

63.7

42.0

61.9

57.6

Zimbabwe South Africa

Table 40: Average age at de-registration of medical specialists by gender and per country

Female medical specialists who de-registered had a higher average age than de-registering male medical specialists in Namibia in 2020. Unlike in Namibia, in South Africa the average age of male medical specialists who de-registered was higher than that of de-registering females in both 2019 and 2020.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.3.6

Active medical specialists in South Africa

Figure 32 shows the number and demographic profiles of active medical specialists in 2020 in South Africa.

2500

60

2000

50 40

1500

30 1000

20

500

10

0

Avgerage Age of Providers

All provinces had more male than female medical specialists in both 2019 and 2020.

No of Providers

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

69

Average Age Male

Figure 32: Number of active medical specialists

The average age of active medical specialists registered on the PCNS in South Africa was 52 years in 2020.

The average age of active male medical specialists across all provinces was above 50, with the Eastern Cape having the highest average age of 56.6 years in 2020.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.3.7

Registration of medical specialists

The number of medical specialists registering declined from 162 in 2019 to 98 in 2020. The decline in registration was experienced across all provinces, except Mpumalanga and the Eastern Cape. Gauteng had the highest number of medical specialists registering. The Northern Cape had no medical specialists registering in 2020. Figure 33 highlights the number and demographic profiles of registering medical

45

70

40

60

35

50

30 25

40

20

30

15

20

10

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

Figure 33: Number of registrations of medical specialists in 2020

Copyright 2022 © Board of Healthcare Funders

Average Age Male

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

0 WESTERN CAPE

10 GAUTENG

5

Avgerage Age of Providers

specialists in 2020 by province.

No of Providers

70

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.3.8

De-registration of medical specialists

In South Africa, the number of de-registering medical specialists increased from 15 in 2019 to 68 in 2020.

More male medical specialists than females de-registered in both years. The average age of medical specialists who de-registered from the PCNS was 57.6 years in 2020, significantly lower than the 63.7 years observed in 2019. Figure 34 shows the average age at de-registration of medical specialists in 2020 by

70

10 9 8 7 6 5 4 3 2 1 0

60 50 40 30 20 10

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

Figure 34: De-registration of medical specialists by gender and age

Copyright 2022 © Board of Healthcare Funders

Average Age Male

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

-

Avgerage Age of Providers

province.

No of Providers

71

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.3.9

Medical specialists per million population

Figure 35 shows the number of medical specialists per million population in 2020 in South Africa. The number of medical specialists per million population was 80 in both 2019 and 2020. The proportion of medical specialists in Gauteng and the Western Cape was significantly higher than in the other provinces in both 2019 and 2020. Limpopo and Mpumalanga had very low proportions (less than 20) of medical specialists per million population in 2019 and 2020.

120 100 80 60 40 20

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

Figure 35: Number of medical specialists per million population per province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

No of medical specialists per million population

72

73

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.4

Pathologists

5.3.4.1

Active pathologists per country

Table 41 summarises the number of active pathologists and number of pathologists per million population by country from 2019 to 2020. The number of active pathologists in Lesotho, Namibia and Zimbabwe remained unchanged over this period. South Africa saw an increase in both the number of pathologists and the number of pathologists per million population. Namibia had the highest density of pathologists per million population in both 2019 and 2020.

ACTIVE PATHOLOGISTS

PATHOLOGISTS PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

2

2

0.0%

0.94

0.93

-1.1%

Namibia

16

16

0.0%

6.41

6.30

-1.7%

Zimbabwe

24

24

0.0%

1.64

1.61

-1.8%

South Africa

260

281

8.1%

4.42

4.71

6.6%

Table 41: Number of pathologists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

74

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.4.2

Movement of pathologists per country

South Africa had 22 registering pathologists in 2020, while no pathologists registered in Lesotho and Zimbabwe in the same year. Only one pathologist registered in Namibia in 2020. The de-registration of pathologists increased in both Namibia and South Africa from 2019 to 2020. Table 42 highlights the movement of pathologists per country in these years.

MOVEMENT OF PATHOLOGISTS Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

2

-

-100%

-

-

-

Namibia

4

1

-75.0%

1

3

200%

Zimbabwe

1

-

-100%

-

-

-

South Africa

16

22

37.5%

1

5

400%

Table 42: Movement of pathologists per country in 2019 and 2020

5.3.4.3

Demographic profile of active pathologists per country

The average age of active pathologists increased across all four countries from 2019 to 2020. Pathologists in Lesotho had the highest average age (55 years) while those in Zimbabwe had the lowest (37 years) in 2020. Table 43 shows the average age of pathologists by country in 2019 and 2020.

AVERAGE AGE OF ACTIVE PATHOLOGISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

54.0

-

54.0

55.0

-

55.0

Namibia

46.5

46.1

46.3

47.5

45.9

46.5

-

36.0

36.0

-

37.0

37.0

49.8

55.8

53.2

50.2

56.0

53.4

Zimbabwe South Africa

Table 43: Average age of pathologists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

75

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.4.4

Average age of pathologists registering per country

Table 44 shows the average age of pathologists registering in 2019 and 2020. Pathologists registering in Lesotho were the oldest on average (54 years), while those registering in Namibia were the youngest (34 years) in 2019.

AVERAGE AGE OF REGISTERING PATHOLOGISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

54.0

-

54.0

-

-

-

Namibia

33.0

34.5

34.0

-

-

-

-

-

-

-

-

-

41.2

41.1

41.2

45.2

44.9

45.0

Zimbabwe South Africa

Table 44: Average age of pathologists registering per country in 2019 and 2020

5.3.4.5

Average age of de-registering pathologists per country

Table 45 shows the average age of de-registering pathologists by gender and country in the years 2019 and 2020. The average age of de-registering pathologists in Namibia decreased significantly, from 55 years in 2019 to 35 years in 2020.

AVERAGE AGE OF DE-REGISTERING PATHOLOGISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

-

55.0

55.0

-

35.0

35.0

Zimbabwe

-

-

-

-

-

-

South Africa

-

72.0

72.0

-

-

-

Table 45: Average age at de-registration by gender and per country

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.4.6

Active pathologists in South Africa

Figure 36 shows the number and demographic profiles of active pathologists in South Africa in 2020.

The number was 281 in 2020, up by 8.1% from 260 in 2019. Of the 281 pathologists, 150 were male.

140

90

120

80 70

100

60

80

50

60

40 30

40

20

20

10

0

Avgerage Age of Providers

The Free State and Northern Cape were the only provinces with more female than male pathologists.

No of Providers

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

76

Average Age Male

Figure 36: Number of active pathologists in 2020

The average age of pathologists was 53.4 years in South Africa in 2020. This is slightly higher than the average age observed in 2019 (53.2 years). The average age of male pathologists was higher than that of female pathologists in both years.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.4.7

Registration of pathologists

Figure 37 highlights the number and demographic profiles of pathologists registering in 2020 by province.

Twenty-two pathologists registered in 2020, more than the 16 who registered in 2019. More female than

14

60

12

50

10

40

8

30

6

20

4

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

FREE STATE

LIMPOPO

KWAZULU-NATAL

0 WESTERN CAPE

10 GAUTENG

2

Avgerage Age of Providers

male pathologists registered in both years.

No of Providers

77

Average Age Male

Figure 37: Number of registrations of pathologists in 2020

The average age of pathologists registering in South Africa increased by 3.8 years to 45 years in 2020, up from 41.2 years in 2019. In 2020, no pathologists registered in four provinces, namely the Free State, Northern Cape, Mpumalanga and North-West.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.4.8

De-registration of pathologists

A total of six pathologists de-registered in 2019 and 2020. Five of these occurred in 2020. The Free State recorded four of these de-registrations, while Gauteng recorded the remaining one.

5.3.4.9

Pathologists per million population

The proportion of pathologists per million population increased from four in 2019 to five in 2020. The Western Cape (10) and Gauteng (eight) had the highest proportion of pathologists per million population in 2020. Figure 38 shows the number of pathologists per million population in South Africa.

12 10 8 6 4 2

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

Figure 38: Number of pathologists per million population per province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

No of pathologists per million population

78

79

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.5

Radiologists

5.3.5.1

Active radiologists per country

The number of active radiologists (eight) in Lesotho did not change from 2019 to 2020. Only Namibia had a decrease in number of active radiologists. It decreased by 11.1%, translating into a decrease of 12.7% per million population. Table 46 summarises the number of active radiologists and number of radiologists per million population per country from 2019 to 2020.

ACTIVE RADIOLOGISTS

RADIOLOGISTS PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

8

8

0.0%

3.76

3.73

-0.8%

Namibia

45

40

-11.1%

18.04

15.74

-12.7%

Zimbabwe

163

167

2.5%

11.13

11.24

1.0%

South Africa

896

926

3.3%

15.24

15.53

1.9%

Table 46: Number of radiologists per country in 2019 and 2020

Namibia had the highest proportion of radiologists per million population in 2020, closely followed by South Africa. In South Africa, the proportion of radiologists per million population was 15.24 in 2019 and 15.53 in 2020.

Copyright 2022 © Board of Healthcare Funders

80

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.5.2

Movement of radiologists per country

There was no movement of radiologists in Lesotho in both 2019 and 2020. The number of radiologists registering in the rest of the countries declined between 2019 and 2020. The number of radiologists deregistering in Namibia declined by 50% from 10 in 2019 to five in 2020, while in South Africa radiologists de-registering increased from four in 2019 to 12 in 2020. Table 47 shows the movement of radiologists per country.

MOVEMENT OF RADIOLOGISTS Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

-

-

-

-

-

-

Namibia

8

5

-37.5%

10

5

-50%

Zimbabwe

12

4

-66.7%

-

-

-

South Africa

77

34

-55.8%

4

12

200%

Table 47: Movement of radiologists per country in 2019 and 2020

5.3.5.3

Demographic profile of active radiologists

Table 48 shows the average age of active radiologists by country in 2019 and 2020. Radiologists in South Africa had the highest average age: 47.7 years in 2020, while active radiologists in Zimbabwe had the lowest average age: 35 years.

AVERAGE AGE OF ACTIVE RADIOLOGISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

39.0

43.6

42.8

40.0

44.6

43.8

Namibia

43.1

45.7

44.6

39.4

46.1

43.2

Zimbabwe

35.0

32.0

33.5

36.0

33.0

35.0

South Africa

45.2

49.2

47.1

45.6

49.8

47.7

Table 48: Average age of radiologists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

81

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.5.4

Average age of radiologists registering per country

In South Africa, the average age of radiologists registering was 39 years in 2019; this declined to 37 years in 2020. Table 49 shows the average age of radiologists registering per country in 2019 and 2020.

AVERAGE AGE OF REGISTERING RADIOLOGISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

32.3

34.8

33.5

20.0

48.0

29.3

Zimbabwe

35.0

32.0

33.5

36.0

-

36.0

South Africa

38.4

39.7

39.0

35.6

38.7

37.0

Table 49: Average age of radiologists registering per country in 2019 and 2020

5.3.5.5

Average age of de-registered radiologists per country

Table 50 shows the average age of de-registering radiologists by gender and country in 2019 and 2020.

The average age of de-registering radiologists in South Africa was higher than in Namibia in both 2019 and 2020. The average age of radiologists de-registering in Namibia declined significantly during this period.

AVERAGE AGE OF DE-REGISTERING RADIOLOGISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

46.6

48.6

47.6

29.7

40.5

34.0

Zimbabwe

-

-

-

-

-

-

South Africa

50.5

61.0

54.0

49.3

71.7

60.5

Table 50: Average age at de-registration by gender and per country

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.5.6

Active radiologists in South Africa

Figure 39 highlights the number of active radiologists in South Africa in 2020. The number increased by 3.3% from 896 to 926 from 2019 to 2020, respectively. Over this period, Gauteng, the Western Cape and KwaZulu-Natal had 72% of active radiologists, leaving only 28% in the other six provinces.

60

350

50

300 40

250

30

200 150

20

100 10

50

Avgerage Age of Providers

400

No of Providers

-

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

82

Average Age Male

Figure 39: Number of active radiologists in 2020

The average age of male active radiologists was higher than that of their female counterparts in both 2019 and 2020. Gauteng and the Eastern Cape were the only provinces with an average age of above 50 years for active radiologists in 2020.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.5.7

Registration of radiologists

There was a 55.8% decrease in the number of radiologists registering, from 77 in 2019 to 34 in 2020. More female radiologists registered in both 2019 and 2020. Figure 40 illustrates the average age at registration of radiologists in 2020 by province.

60

20

50

16 14

40

12 10

30

8 20

6 4

10

2 0

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

Figure 40: Number of registrations of radiologists in 2020

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

-

Average Age Male

Avgerage Age of Providers

18

No of Providers

83

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.5.8

De-registration of radiologists

In South Africa, the number of radiologists de-registering increased from four in 2019 to 12 in 2020. Only male radiologists from Gauteng and the Western Cape provinces de-registered. Figure 41 shows the average age at de-registration of radiologists in 2020 by province.

120 100

3 80 2

60 40

1 20

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

Figure 41: De-registration of radiologists by gender and age

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

Average Age Male

Avgerage Age of Providers

4

No of Providers

84

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.5.9

Radiologists per million population

Figure 42 shows the number of radiologists per million population in South Africa in 2020. Approximately 15 radiologists per million population registered on the PCNS in 2019 and 2020. Only Gauteng and KwaZulu-Natal experienced an increase in the number of radiologists during this time. Four provinces had less than 10 radiologists per million population in the same period.

30 25 20 15 10 5

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

Figure 42: Number of radiologists per million population per province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

No of radiologists per million population

85

86

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.6

Surgical specialists

5.3.6.1

Active surgical specialists per country

Table 51 shows the number of active surgical specialists by country in 2019 and 2020. The number of active surgical specialists increased for all countries. South Africa had the lowest increase: 1.9%.

ACTIVE SURGICAL SPECIALISTS

SURGICAL SPECIALISTS PER 1 000 000 POPULATION

2019

2020

% Change

2019

2020

% Change

Lesotho

11

12

9.1%

5.18

5.60

8.1%

Namibia

105

109

3.8%

42.09

42.90

1.9%

Zimbabwe

212

225

6.1%

14.48

15.14

4.6%

3 184

3 244

1.9%

54.17

54.41

0.4%

South Africa

Table 51: Number of surgical specialists per country in 2019 and 2020

South Africa had the highest proportion of active surgical specialists per million population: 54.41 in 2020, while Lesotho had the lowest proportion: 5.6 active surgical specialists per million population. Lesotho had the highest increase in surgical specialists per million population compared to other countries, 8.1% between 2019 and 2020. In the same period Zimbabwe had a significant increase of 6.1% of active surgical specialists.

Copyright 2022 © Board of Healthcare Funders

87

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.6.2

Movement of surgical specialists by country

Table 52 shows the movement of surgical specialists by country over the two-year period to 2020. The number of surgical specialists registering declined for all countries except Zimbabwe, where it increased from 11 in 2019 to 13 in 2020. In South Africa the number of specialists registering fell by 24% to 67 in 2020; it fell by 38.5% to 8 in Namibia.

MOVEMENT OF SURGICAL SPECIALISTS Registration

De-registration

2019

2020

% Change

2019

2020

% Change

Lesotho

2

1

-50.0%

-

-

-

Namibia

13

8

-38.5%

5

6

20%

Zimbabwe

11

13

18.2%

-

2

-

South Africa

88

67

-23.9%

7

25

257.1%

Table 52: Movement of surgical specialists per country in 2019 and 2020

Lesotho had no surgical specialists de-registering in 2019 and 2020. The rest of the countries experienced an increase in the number of surgical specialists de-registering from 2019 and 2020.

5.3.6.3

Average age of active surgical specialists per country

South Africa had the highest average age of active surgical specialists compared to other countries for both 2019 and 2020: 53 years in 2020. In Zimbabwe active surgical specialists had an average age of 37.1 years in 2020, while in Namibia and Lesotho the average was 50.5 years and 52.4 years, respectively. Table 53 highlights the average age of surgical specialists per country in 2019 and 2020.

AVERAGE AGE OF ACTIVE SURGICAL SPECIALISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

53.0

50.9

51.1

54.0

52.2

52.4

Namibia

58.3

48.7

49.7

57.2

49.6

50.5

Zimbabwe

34.0

36.5

35.3

35.0

37.5

37.1

South Africa

45.2

53.3

52.4

45.6

54.0

53.0

Table 53: Average age of surgical specialists per country in 2019 and 2020

Copyright 2022 © Board of Healthcare Funders

88

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.6.4

Average age of surgical specialists registering per country

The average age of surgical specialists registering increased from 2019 to 2020 across all countries included in the report, except South Africa. In South Africa, the average age of registering surgical specialists was unchanged at 37.5 years for both 2019 and 2020. Table 54 highlights the average age of surgical specialists registering in 2020.

AVERAGE AGE OF REGISTERING SURGICAL SPECIALISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

49.5

49.5

-

55.0

55.0

Namibia

-

43.8

43.8

38.0

49.5

45.7

Zimbabwe

34.0

38.0

36.0

-

37.5

37.5

South Africa

38.3

37.3

37.5

34.8

38.5

37.5

Table 54: Average age of surgical specialists registering per country in 2020

5.3.6.5

Average age of de-registered surgical specialists per country

Table 55 shows the average age of surgical specialists de-registering by gender and country in 2019 and 2020. The average age of de-registering surgical specialists was higher in South Africa (76.5 years) than in Namibia (42.8 years) in 2020.

AVERAGE AGE OF DE-REGISTERING SURGICAL SPECIALISTS 2019

2020

Female

Male

Total

Female

Male

Total

Lesotho

-

-

-

-

-

-

Namibia

-

49.6

49.6

-

42.8

42.8

Zimbabwe

-

-

-

-

-

-

67.0

64.7

65.0

-

76.5

76.5

South Africa

Table 55: Average age of de-registration by gender and per country

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.6.6

Active surgical specialists in South Africa

Figure 43 illustrates the number and demographic profiles of active surgical specialists in 2020 in South Africa. Active surgical specialists registered on the PCNS grew by 1.9% from 2019 to 2020. Of the 3 244 active surgical specialists in 2020, approximately 85% were male. Gauteng had the most active surgical specialists compared to other provinces in both 2019 and 2020.

1600

50

1200 40

1000 800

30

600

20

400 10

200

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

GAUTENG

0

Avgerage Age of Providers

60

1400 No of Providers

89

Average Age Male

Figure 43: Number of active surgical specialists in 2020

The average age of active surgical specialists in South Africa increased from 52.4 years in 2019 to 53 years in 2020. The average age of active male surgical specialists was higher than that of active female specialists across all provinces in both years.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.6.7

Registration of surgical specialists

In South Africa, there was a decrease in the number of registrations of surgical specialists from 88 in 2019 to 67 in 2020. There were more male surgical specialists than females registering in both 2019 and 2020.

30

10

20

5

10

0

-

Number of HSPs Male

Number of HSPs Female

Average Age Female

Average Age Total

NORTH WEST

15

EASTERN CAPE

40

MPUMALANGA

20

NORTHERN CAPE

50

LIMPOPO

25

FREE STATE

60

KWAZULU-NATAL

30

WESTERN CAPE

70

GAUTENG

35

Avgerage Age of Providers

Figure 44 shows the average age at registration of surgical specialists in 2020 by province.

No of Providers

90

Average Age Male

Figure 44: Number of registrations of surgical specialists in 2020

In 2020, the average age of male surgical specialists registering was higher than that of female surgical specialists across most provinces.

Copyright 2022 © Board of Healthcare Funders

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

5.3.6.8

De-registration of surgical specialists

The number of surgical specialists who de-registered in South Africa was 7 in 2019 and 25 in 2020. The average age of surgical specialists who de-registered increased significantly from 65 years in 2019 to 76.5 years in 2020. Gauteng, KwaZulu-Natal and the Western Cape were the only provinces to experience deregistration of surgical specialists in both 2019 and 2020.

5.3.6.9

Surgical specialists per million population

The proportion of surgical specialists per million population registered on the PCNS was approximately 54 between 2019 and 2020 in South Africa. The Western Cape had the highest proportion of surgical specialists per million population in 2019 and 2020, above 105 in both years.

Limpopo, Free State and the Eastern Cape are the only provinces that recorded an increase in the number of surgical specialists per million population from 2019 to 2020. The Northern Cape was the only province with a decline in surgical specialists per million population. Figure 45 shows the number of surgical specialists per million population in 2019 and 2020.

120 100 80 60 40 20

2019 Proportion per million population

2020 Proportion per million population

2019 South Africa Average

2020 South Africa Average

Figure 45: Number of surgical specialists per million population per province

Copyright 2022 © Board of Healthcare Funders

NORTH WEST

EASTERN CAPE

MPUMALANGA

NORTHERN CAPE

LIMPOPO

FREE STATE

KWAZULU-NATAL

WESTERN CAPE

0 GAUTENG

No of surgical specialists per million population

91

92

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

6.1 Conclusions The distribution of healthcare professionals is uneven across the four countries, with South Africa having higher proportions across most disciplines. Namibia is experiencing a rapid growth in the number of healthcare professionals across most disciplines. Within South Africa, Gauteng and the Western Cape have a much higher density than the other seven provinces.

The number of primary care professionals (FPs, dentists and SAHPs) remained relatively stable from 2019 to 2020. It increased moderately during that time. The number of healthcare professionals registering on the PCNS declined from 2019 to 2020, while the number of de-registering professionals increased significantly.

The number of specialists per population varies greatly by country and even more by province in the South African context. Overall, the proportion of specialists per population is very low; some countries have no healthcare professionals in certain disciplines, while for some disciplines the proportions are as low as 0.5 per million population.

What is more concerning with regard to specialists is the overall movement and demographic trends. The average age of specialists with active practice numbers is very high - above 52 years. The number of specialists registering on the PCNS declined significantly from 2019 to 2020. This may be attributable to the COVID-19 pandemic. The number of specialists de-registering was very high in 2020, much higher compared to 2019.

There is no single health human resource for health database in South Africa; this is probably also the case in the neighbouring countries.

Copyright 2022 © Board of Healthcare Funders

93

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

6.2 Recommendations The uneven distribution of human resources is a concern both within countries and across countries. It is important that measures be put in place to monitor the distribution of healthcare professionals in both contexts. Once this is done, interventions may be developed to optimise the availability of HRH. In South Africa, the National Department of Health should perhaps consider revisiting the Certificate of Need to address the geographical imbalances of the health workforce. Other interventions such as incentives may also be considered to address the maldistribution.

Across the countries there are limited numbers of specialists, which appear to be declining consistently.

Policies to increase the supply of specialists across multiple disciplines and retain these in practice for as long as possible need to be put in place as a matter of priority.

In some countries the data on healthcare professionals were of poor quality. This compromised the ability to identify key demographic trends. It is important that measures be put in place to improve data quality.

The data shared in this report are only for practitioners who have registered on the PCNS and who are in private practice. The report does not give a complete picture of all healthcare professionals available at both national and regional levels. It is therefore important to put in place a reporting mechanism that includes all healthcare professionals in practice.

Copyright 2022 © Board of Healthcare Funders

94

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

1.

Anand S, Bärnighausen T. Health workers and vaccination coverage in developing countries: an econometric analysis. Lancet 2007; 369: 1277-1285.

2.

George G, Quinlan T, Reardon C, Aguilera JF. Where are we short and who are we short of? A review of the human resources for health in South Africa. Health SA Gesondheid 2012; 17(1): 1-7. https://doi.org/10.4102/hsag.v17i1.622

3.

Naicker S, Plange-Rhule J, Tutt RC, Eastwood JB. Shortage of healthcare workers in developing countries - Africa. Ethnicity and Disease 2009; 19 (Suppl 1).

4.

Rispel LC, Blaauw D, Ditlopo P, White J. Human resources for health and universal health coverage: progress,

complexities

and

contestations.

South

African

Health

Review

2018;

13-21.

https://hdl.handle.net/10520/EJC‐14490ad809 5.

Speybroeck N, Kinfu Y, Dal Poz MR, Evans DB. Reassessing the Relationship Between Human Resources for

Health,

Intervention

Coverage

and

Health

Outcomes,

2006.

http://wwwlive.who.int/entity/hrh/documents/reassessing_relationship.pdf 6.

World Health Organization. The World Health Report 2006: Working Together for Health. Geneva: World Health Organization, 2006. https://www.who.int/whr/2006/whr06_en.pdf

7.

Council for Medical Schemes. Annual Report 2017|2018 A Healthy Industry for All, 2018. Available at: https://www.medicalschemes.com/publications.aspx.

Copyright 2022 © Board of Healthcare Funders

95

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

CODE

DISCIPLINE DESCRIPTION

GROUP

10

Anaesthetists (10)

Anaesthetists

62

Maxillo-facial and Oral Surgery (62)

Dental Specialists

64

Orthodontics (64)

Dental Specialists

92

Periodontics (92)

Dental Specialists

93

Dental Technician (93)

Dental Specialists

94

Prosthodontic (94)

Dental Specialists

95

Dental therapy (95)

Dental Specialists

98

Oral pathology (98)

Dental Specialists

54

General Dental Practice (54)

Dentists

14

General Medical Practice (14)

Family Practitioners

15

Specialist Family Medicine (15)

Family Practitioners

12

Dermatology (12)

Medical Specialists

16

Independent Practice Specialist Obstetrics and Gynaecology (16)

Medical Specialists

17

Pulmonology (17)

Medical Specialists

18

Independent Practice Specialist Medicine (18)

Medical Specialists

20

Neurology (20)

Medical Specialists

21

Cardiology (21)

Medical Specialists

22

Psychiatry (22)

Medical Specialists

23

Medical Oncology (23)

Medical Specialists

27

Clinical Haematology (27)

Medical Specialists

29

Occupational Medicine Independent Practice Specialist (29)

Medical Specialists

31

Rheumatology (31)

Medical Specialists

32

Paediatrics Independent Practice Specialist (32)

Medical Specialists

34

Physical Medicine (34)

Medical Specialists

35

Emergency Medicine Independent Practice Specialist (35)

Medical Specialists

40

Independent Practice Specialist Radiation Oncology (40)

Medical Specialists

97

Independent Practice Specialist Public Health Medicine (97)

Medical Specialists

112

Independent Practice Specialist Clinical Pharmacology (112)

Medical Specialists

114

Paediatric Surgery Independent Practice Specialist (114)

Medical Specialists

33

Paediatric Cardiology (33)

Medical Specialists

37

Medical technology (37)

Medical Technology

25

Nuclear Medicine (25)

Pathology

52

Pathology Independent Practice Specialist (52)

Pathology

38

Diagnostic Radiology (38)

Radiology

Copyright 2022 © Board of Healthcare Funders

96

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

CODE

DISCIPLINE DESCRIPTION

GROUP

39

Radiography (39)

Radiology

119

Namibia Only

SAHP

11

Ambulance Services - Intermediate (11)

SAHP

63

Primary Care Drug Therapist (63)

SAHP

210

State Registered Nurses (210) (Zimbabwe)

SAHP

211

Zimbabwe Red Cross Society (211) (Zimbabwe)

SAHP

2

Nutritionist (2)

SAHP

3

Accredited Blood and Blood Product Couriers (3)

SAHP

4

Chiropractors (4)

SAHP

6

Foreign Services (6)

SAHP

7

Namibian Practitioners Only (Not recognized by (HPCSA) (7)

SAHP

8

Homoeopaths (8)

SAHP

9

Ambulance Service (9)

SAHP

48

Travel Clinic (48)

SAHP

50

Group Practice (50)

SAHP

51

Group practices/Hospitals (51)

SAHP

60

Pharmacies (60)

SAHP

61

Pharmacotherapies (61)

SAHP

65

Counsellor (Lesotho Practitioners only) (65)

SAHP

66

Occupational Therapy (66)

SAHP

67

Art Therapists (67)

SAHP

68

Podiatry (68)

SAHP

69

Medical Scientist (69)

SAHP

70

Optometrists (70)

SAHP

71

Optical dispensers (71)

SAHP

72

Physiotherapists (72)

SAHP

73

Masseurs (73)

SAHP

74

Orthoptists (74)

SAHP

75

Clinical technology (75)

SAHP

78

Blood transfusion services (78)

SAHP

80

Nursing Agencies/Home Care Services (80)

SAHP

81

Registered Counsellors (81)

SAHP

82

Speech Therapy and Audiology (82)

SAHP

83

Hearing Aid Acoustician (83)

SAHP

84

Dieticians (84)

SAHP

85

Psychometry (85)

SAHP

Copyright 2022 © Board of Healthcare Funders

97

Pr ac tic e Code Numbe ri ng Sys tem [PCNS ] Re port 2019 /2020

CODE

DISCIPLINE DESCRIPTION

GROUP

86

Psychologists (86)

SAHP

87

Orthotists & Prosthetists (87)

SAHP

88

Registered nurses (88)

SAHP

89

Social workers (89)

SAHP

90

Clinical services (90)

SAHP

91

Biokinetics (91)

SAHP

96

Community dentistry (96)

SAHP

99

Psychological Counsellors - Namibian Practitioners Only (99)

SAHP

101

Naturopathy (101)

SAHP

102

Osteopathy (102)

SAHP

103

Phytotherapy (103)

SAHP

104

Ayurveda (104)

SAHP

105

Acupuncturist (105)

SAHP

106

Therapeutic Aromatherapist (106)

SAHP

107

Therapeutic Massage Therapist (107)

SAHP

108

Therapeutic Reflexologist (108)

SAHP

109

Unani-Tibb (109)

SAHP

110

Clinical Pharmacokinetics (110)

SAHP

111

Radiopharmacist (111)

SAHP

113

Oral Hygiene (113)

SAHP

115

Medical Genetics (115)

SAHP

116

Basic Life Support Staff (116)

SAHP

117

Intermediate Life Support Staff (117)

SAHP

118

Advanced Life Support Staff (118)

SAHP

13

Basic Life Support (13)

SAHP

19

Gastroenterology (19)

Surgical Specialists

24

Independent Practice Specialist Neurosurgery (24)

Surgical Specialists

26

Ophthalmology (26)

Surgical Specialists

28

Orthopaedics (28)

Surgical Specialists

30

Otorhinolaryngology (30)

Surgical Specialists

36

Plastic and Reconstructive Surgery (36)

Surgical Specialists

42

Surgery Independent Practice Specialist (42)

Surgical Specialists

44

Cardio Thoracic Surgery (44)

Surgical Specialists

46

Urology (46)

Surgical Specialists

Copyright 2022 © Board of Healthcare Funders

THIS REPORT WAS PREPARED BY THE BOARD OF HEALTHCARE FUNDERS Company Registration No. 2001/003387/08 Lower Ground Floor, South Tower 1Sixty Jan Smuts, Rosebank, 2196 P O Box 2863, Saxonwold, 2132 T. +27 11 537-0200 F. +27 11 880-8798 E. bhf@bhfglobal.com W. www.bhfglobal.com