Community service for health professionals : human resources
2002
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.
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