Abstract

BackgroundIn South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Community service officers are required to contribute a year towards serving in a public health facility while receiving supervision and remuneration. Although the South African community service programme has been in effect since 1998, little is known about how placement and practical support occur, or how community service may impact future retention of health professionals.MethodsNational, cross-sectional data were collected from community service officers who served during 2009 using a structured self-report questionnaire. A Supervision Satisfaction Scale (SSS) was created by summing scores of five questions rated on a three-point Likert scale (orientation, clinical advising, ongoing mentorship, accessibility of clinic leadership, and handling of community service officers’ concerns). Research endpoints were guided by community service programmatic goals and analysed as dichotomous outcomes. Bivariate and multivariate logistical regressions were conducted using Stata 12.ResultsThe sample population comprised 685 doctors and dentists (response rate 44%). Rural placement was more likely among unmarried, male, and black practitioners. Rates of self-reported professional development were high (470 out of 539 responses; 87%). Participants with higher scores on the SSS were more likely to report professional development. Although few participants planned to continue work in rural, underserved communities (n = 171 out of 657 responses, 25%), those serving in a rural facility during the community service year had higher intentions of continuing rural work. Those reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities.ConclusionsDespite challenges in equitable distribution of practitioners, participant satisfaction with the compulsory community service programme appears to be high among those who responded to a 2009 questionnaire. These data offer a starting point for designing programmes and policies that better meet the health needs of the South African population through more appropriate human resource management. An emphasis on professional development and supervision is crucial if South Africa is to build practitioner skills, equitably distribute health professionals, and retain the medical workforce in rural, underserved areas.

Highlights

  • In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development

  • Factors that contributed to satisfaction in community service professional development In Figure 3, we explored how socio-demographics, placement characteristics, and management experiences were associated with community service officer satisfaction

  • Conclusions the community service programme articulates the goal of ‘equitably’ distributing health professionals throughout the country, our analysis suggests that important inequities deserve attention

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Summary

Introduction

In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Half of the global population lives in rural areas, but these regions have access to less than a quarter of the world’s medical doctors [1]. This geographical and class disparity is most pronounced in resource-constrained settings and has been documented globally [2,3,4,5,6]. While nearly half (approximately 43.7%) of the population lives in rural areas in South Africa, rural communities have access to only 12% of the country’s doctors [8,9]. With an inadequate labour force, health care delivery is compromised and poor health indicators impact progress towards the Millennium Development Goals in South Africa

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