Personnel shortage is a serious problem given the rural nature of the province, making recruitment and retention of health care professionals difficult. For example, at Nala Hospital, which is an ARV site, there are no doctors. The staff establishment was declining due to declining funds allocated to staff salaries. Occupation Specific Dispensation (OSD) has not assisted the situation. It often complicates matters by, for example, requiring funds to be shifted away from vacant posts. The rural nature of the province, especially in places like Qwaqwa where accommodation was scarce, presented a challenge to attracting health care professionals. Advertising was done via the centralised provincial government advertisements and was no longer a departmental function. This posed a challenge in filling posts quickly. A nursing school in Thaba Nchu was opened, addressing the accommodation needs of nursing students. There was a need to prioritise and balance staff and goods and services. The department was currently reviewing the structure of the department which was currently divided into four clusters: finance, resources, clinical (district) and strategic programmes. There was a lack of proper co- ordination between the Corporate Office and the districts, which the department claimed to be correcting. In particular, the department was reviewing the large administration staff (versus the need for clinical skills). The Performance management system (PDMS) was faced with challenges. Health care workers wrongly viewed this as a cash bonus or pay progression, whereas it was supposed to be a performance- based bonus. In 2007/08 and 2008/09 the department had no cash for the bonuses. A court order required the department to pay but due to financial constraints this was not done- i.e. the department had not budgeted for it.