Community service for health professionals : human resources

The one-year period of community service (CS) for health professionals has been implemented since 1998, with doctors, dentists and pharmacists now being routinely allocated to a 12-month period of service in public institutions, on completion of their formal training. A further 7 professional groups will follow in 2003, including physiotherapists, occupational and speech therapists, clinical psychologists, dieticians, radiographers and environmental health officers. the aim of CS, according to the Department of Health, is "to ensure improved provision of health services to all citizens of the country". the chapter reports on a number of findings that are measured against this overall goal. With respect to the responses of all three professional groups currently undergoing CS, there were a number of patterns that were notably similar. Firstly, despite difficulties and frustrations, the majority felt that they had made a difference and had undergone some professional development. Overall, most described their experience of the year as positive in retrospect, but only a minority reported that their attitude had become more positive during the year. Supervision of CS doctors, dentists and pharmacists by more senior professionals was found to be significantly poorer in rural than in urban settings. the dentists showed the greatest gap, between their skills and expectations as university graduates, and the needs and context of oral health in the public service. CS pharmacists, who had completed their internships in the retail sector, were also initially disorientated in the public health sector, but their skills and knowledge were valued and appreciated particularly where there had been no pharmacist before. Doctors varied widely in their level of preparedness not only in skills but also in attitudes. Language gaps were also found to be a factor. CS highlights the general management deficiencies in the public health system. All groups expressed dissatisfaction at the conditions of service in the public sector, but particularly the pharmacists, many of whom had exposure to the private sector during their internships. Many of the dentists, who have a particular reliance on specialised equipment and supplies, found themselves unable to perform any but the most basic procedures. A feature of all these young professionals is the alarming proportion of between 20% and 45% that are planning to work overseas after their CS. Recommendations include the need for a comprehensive national plan for the recruitment and retention of health professionals in rural and under-served areas that include other complementary strategies besides CS. Health Science Faculties need to address the gaps between the skills and attitudes of their graduates, and the realities of the health of the South African public as experienced by CS professionals. Supervision of CS professionals in rural areas needs to be improved through direct support by health managers, as well as the support of senior clinicians in the health system, through appropriate promotions and acknowledgement. the CS strategy should be reviewed after 5 years, to evaluate whether it is achieving the goal for which it was instituted.