"Bringing health workers into public service on the African continent"
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government bodies, private sector institutions and civil society organisations.
The Doctors’ Support Programme is only one year old, but practice managers have already made great strides in assisting doctors improve the quality of healthcare communities receive.
The programme started in three districts in the Eastern Cape and the three practice managers, one dedicated to each district, developed relationships with doctors and other medical staff and organised regular continued professional development (CPD) sessions for doctors. They also assisted doctors with administrative problems and assisted hospital managers with minor equipment repairs and purchases.
One of the greatest challenges facing countries worldwide is ensuring communities in rural areas have access to well-trained healthcare professionals. Approximately half of the global population lives in rural areas, but they are served by only 38% of the total nursing workforce and by less than a quarter of the total physician workforce – according to a 2010 World Health Organisation report relating to the retention of health workers in rural areas. In South Africa 46,3% of the population lives in rural areas and these communities are served by only 19% of nurses and 12% of doctors.
The WHO mentions several factors that influence the decision by healthcare professionals whether or not to work in rural facilities. These include working and living conditions (infrastructure, working environment, and access to medical supplies and technology) and career options (access to education opportunities and professional development courses). The WHO says that offering professional and personal support to reduce isolation is vital in improving the retention of healthcare professionals in rural areas. [i]
AHP’s practice managers play a key role in offering support to doctors. All the challenges facing doctors and management teams cannot be solved in a year and practice managers still have a lot of hard work ahead of them this year. The Doctors’ Support Programme has also been expanded and is now supporting doctors in eight districts.
At the last CPD session and year-end function in the Joe Gqabi district in the Eastern Cape, district management teams and chief medical officers raised many challenges that call for the practice manager Hluma Zakaza’s support.
These challenges include accommodation, retention of medical officers, staffing gaps, safety concerns, lack of equipment and drugs, and the need for more recreational facilities for doctors. These issues are not unique to the Joe Gqabi district or even to South Africa. The WHO strongly recommends that countries worldwide improve living conditions of health workers and invest in infrastructure to keep doctors in rural areas. A safe working environment where health professionals have access to supplies and equipment and are supervised and mentored by experienced professionals is mentioned as a useful strategy to increase the retention of health workers. [i]
A call was also made at the meeting for the improvement of bursary systems for rural pupils – the application process was described as unfair to rural schools, and concerns relating to a lack of monitoring of students after they had completed their studies were raised. To increase the retention of healthcare professionals in rural areas, the WHO recommends that countries award bursaries on the condition that graduates work in rural areas. [i]
Stakeholders in the Joe Gqabi district said poor communication hampers their efforts to provide quality healthcare. Incidents of unprofessional leadership, lack of clear communication channels, and poor internet access were raised as issues that had to be addressed. Several suggestions to improve these challenges were mooted including improving networks, developing a clear plan of action, improving email systems and information sharing, and using the national Department of Health website more effectively.
Participants also said doctors are not consulted on the procurement of medical equipment and that they are often not paid for working overtime. Stakeholders felt that there was a great need for well-trained ambulance assistants and paramedics in the district. Referral systems had to be improved and district specialists need to be added to eliminate unnecessary referrals to hospitals outside the district. A stipulated number of doctors had to be on call at all times and more full-time doctors should be recruited. More CPD sessions to improve the skills of all healthcare professionals should be organised.
Practice managers, with the doctors they support, have to overcome many hurdles as they work towards achieving quality healthcare for patients in rural areas. By reducing the isolation doctors experience and improving their working environment practice managers are not only making a difference in the lives of doctors, but also improving the standard of care in rural facilities.
1. World Health Organisation. (2010). “Increasing access to health workers in remote and rural areas through improved retention.” Available from: http://www.who.int/hrh/retention/guidelines/en/index.html