Placement, support, and retention of health professionals: national, cross-sectional findings from medical and dental community service officers in South Africa

Abstract

Background: In 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.

Methods: National, 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.

Results: The 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.

Conclusions: Despite 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.

Figure 1

Unadjusted (dark grey) and adjusted (grey) associations between rural placement and key socio-demographic and medical school characteristics as predictors (n = 639). Data are presented as odds ratios. Ninety-five percent confidence intervals are illustrated by error bars. UKZN: University of KwaZulu-Natal. Statistical significance is presented with an asterisk to indicate the relative level of statistical significance (*P < 0.05 (statistically significant), **P < 0.01, ***P < 0.001 (statistically highly significant).

Figure 2

Unadjusted (dark grey) and adjusted (grey) associations between receiving first choice of placement and key predictors (n = 670). Data are presented as odds ratios. Ninety-five percent confidence intervals are illustrated by error bars. UKZN: University of KwaZulu-Natal. Statistical significance is presented with an asterisk to indicate the relative level of statistical significance (*P < 0.05 (statistically significant), **P < 0.01, ***P < 0.001 (statistically highly significant).

Figure 3

Unadjusted (dark grey) and adjusted (grey) associations between professional development and key predictors (n = 483). Data are presented as odds ratios. Ninety-five percent confidence intervals are illustrated by error bars. UKZN: University of KwaZulu-Natal. ^aVariable omitted from multivariate model due to colinearity with level of health facility. Statistical significance is presented with an asterisk to indicate the relative level of statistical significance (*P < 0.05 (statistically significant), **P < 0.01, ***P < 0.001 (statistically highly significant).

Figure 4

Unadjusted (dark grey) and adjusted (grey) associations between public sector work intentions and key predictors (n = 469). Data are presented as odds ratios. Ninety-five percent confidence intervals are illustrated by error bars. UKZN: University of KwaZulu-Natal. ^aVariable omitted from multivariate model due to missing data. Statistical significance is presented with an asterisk to indicate the relative level of statistical significance (*P < 0.05 (statistically significant), **P < 0.01, ***P < 0.001 (statistically highly significant).

Figure 5

Unadjusted (dark grey) and adjusted (grey) associations between intention to work in rural or underserved communities in the future and key predictors (n = 460). Data are presented as odds ratios. Ninety-five percent confidence intervals are illustrated by error bars. UKZN: University of KwaZulu-Natal. Statistical significance is presented with an asterisk to indicate the relative level of statistical significance (*P < 0.05 (statistically significant), **P < 0.01, ***P < 0.001 (statistically highly significant).