Temporary solutions vs other
COMMUNITY SERVICE from RURAL DOCTORS ASSOCIATION OF SOUTHERN AFRICA (RUDASA) POSITION PAPER: JANUARY 2001
CRISIS IN STAFFING OF RURAL HOSPITALS
Community service (CS) has improved the situation in some provinces, but two serious shortcomings of the scheme are becoming apparent: the lack of senior doctors to supervise them, and the fact that only a quarter of CS doctors are in fact allocated to rural hospitals. The most needy hospitals appear to be avoided by CS doctors in their choices, and a number of rural hospitals in the Eastern Cape which desperately need more staff, for example, have no CS doctors in 2001. In addition, the annual turnover of CS doctors who need to be trained on the job each year, and the high proportion of them who head overseas after their year, are issues of concern.
Recommendation:
The allocation process for community service be redrawn to ensure that the most needy rural hospitals receive doctors before filling posts in urban tertiary hospitals.
Community service be viewed as a training year, requiring appropriate input and supervision (mentoring) and a clear structure.
Undergraduate and intern training to achieve specific levels of competencies in at least Caesarian sections and anaesthesia, such that CS doctors can perform these tasks independently in rural hospitals.
Time for a community driven approach or hope
Hope: Students From the Underserved, For the Underserved
RURAL DOCTORS ASSOCIATION OF SOUTHERN AFRICA (RUDASA)
POSITION PAPER: JANUARY 2001
CRISIS IN STAFFING OF RURAL HOSPITALS
INTRODUCTION
This short paper aims to bring to the attention of policy-makers and senior managers in the provincial and national Departments of Health (DoH), and the Health Professionals Council of SA (HPCSA), the crisis that is currently facing many rural hospitals in the country in terms of staffing by Medical Officers, particularly those at a senior level with experience. RUDASA is seeking constructive solutions to the issues of recruitment and retention of professional staff in rural areas, and the recommendations below are given in a sincere attempt to advocate for the health of our patients, from the perspective of the frontline of health care in rural and underserved districts.
1. COMMUNITY SERVICE
Community service (CS) has improved the situation in some provinces, but two serious shortcomings of the scheme are becoming apparent: the lack of senior doctors to supervise them, and the fact that only a quarter of CS doctors are in fact allocated to rural hospitals. The most needy hospitals appear to be avoided by CS doctors in their choices, and a number of rural hospitals in the Eastern Cape which desperately need more staff, for example, have no CS doctors in 2001. In addition, the annual turnover of CS doctors who need to be trained on the job each year, and the high proportion of them who head overseas after their year, are issues of concern.
Recommendations:
· The allocation process for community service be redrawn to ensure that the most needy rural hospitals receive doctors before filling posts in urban tertiary hospitals.
· Community service be viewed as a training year, requiring appropriate input and supervision (mentoring) and a clear structure.
· Undergraduate and intern training to achieve specific levels of competencies in at least Caesarian sections and anaesthesia, such that CS doctors can perform these tasks independently in rural hospitals.
2. SENIOR SOUTH AFRICAN DOCTORS
The recruitment and retention of senior doctors who are prepared to commit themselves to the longer term in rural practice, is an issue that demands a comprehensive approach. The issues that need to be addressed include student selection, the orientation of undergraduate and postgraduate training, provincial study bursaries, the rural allowance and other incentives, non-monetary incentives, and posts for follow-on employment after community service.
Secondly, the public service ruling that any new appointment must occupy a first-leg Medical Officer post until that post is upgraded, is severely hampering efforts by rural superintendents to recruit doctors from other positions.
Thirdly, those community service doctors who show an interest in pursuing a career in rural medicine need to be encouraged by appropriate incentives or bursaries for further study.
Recommendations
· The DoH to plan with relevant stakeholders, a comprehensive strategy to attract and retain senior doctors in the public health system. These stakeholders should include the medical universities, provincial departments of health, and RUDASA.
· The specific recruitment of South African-qualified doctors back from Canada and the United Kingdom, to work in rural hospitals in South Africa, needs to be given attention by provincial health departments. This cannot be accomplished without significant incentives, and the involvement of the national DoH.
· Opportunities be provided for and/or created to allow for the promotion-on-transfer of doctors to rural hospitals
· Those who have served an extra year in a rural or underserved area, should be given preference for specialist training posts as registrars, as they have been relatively disadvantaged by giving their service away from the academic centres.
3. CUBAN DOCTORS
Cuban doctors have alleviated the crisis in a number of provinces, but two shortcomings of this scheme have become increasingly obvious. Since Cuban doctors are trained as specialists, their lack of generalist skills makes it difficult for most Cubans to handle the wide scope of rural practice in South Africa, unless they are family physicians who are prepared to learn anaesthetics and procedural skills. Secondly, the cultural and language differences make communication difficult.
Recommendations
· If the scheme is to be continued, more family physicians who are prepared to cover all specialities need to be recruited into the scheme.
· Proficiency in the English language needs to be a prerequisite for entrance.
4. FOREIGN DOCTORS
Foreign doctors from other countries have filled the gap in many rural hospitals for years, and have provided the senior support and experience that is vital in many institutions. However, with the successively tight restrictions on the registration of foreign-qualified doctors by the HPCSA, together with the increasing difficulties foreign doctors experience with the Department of Home Affairs in obtaining and renewing work permits, this essential source of doctors for rural hospitals has been completely cut off. This does not make sense with respect to the countries which can afford to export doctors, and those whose graduates were recognized in SA until recently (e.g. UK, Belgium, etc). Those foreign doctors already providing valuable, often irreplaceable service in rural hospitals are being made to feel increasingly insecure and unwelcome, and are migrating in significant numbers to other countries where they are welcomed, thus further depleting South African rural hospitals of experienced personnel.
Recommendations
· That restrictions on registration of foreign-qualified doctors from those countries which have an adequate number of doctors, be lifted immediately.
· That appropriate recognition be given to those foreign-qualified doctors who have served in rural hospitals for more than 10 years, in terms of promotion.
· That a consultation be arranged between the Department of Health, the HPCSA and the Department of Home Affairs to ensure there is a common understanding of the role of foreign doctors and approach to their employment in rural areas.
CONCLUSION
It is clear that a co-ordinated and comprehensive approach to the staffing of rural hospitals is needed, both to address the present crisis and to plan for the future.
Thus it is recommended that a rural health unit be established in the Department of National Health to ensure adequate staffing of rural hospitals, in terms of all categories of professionals, and to work with bodies such as the HPCSA and Universities as part of a comprehensive strategy.
Drafted by Dr Steve Reid
RUDASA Chairman: Dr Ian Couper
RUDASA Secretary: Dr Elma de Vries
Correspondence to: The Secretary, RUDASA, PO 1833, Brackenfell 7561
e-mail: elmadv@mweb.co.za
RUDASA is a voluntary organization of rural doctors in the public and private sectors