The Japanese could give us some pointers on how to =20 attract doctors to rural hospitals, writes David =20
MUCH attention has been given to alleviating the =20 chronic shortage of doctors for rural service both here =20 and elsewhere. The Department of National Health’s =20 drive towards the development of a health care system =20 based on the principles of primary health care will, in =20 part, depend for its success on a planned supply of =20 doctors willing to work in rural areas. The new system =20 will be primarily staffed by primary health care nurses =20 clinically supported by doctors in community health =20 centres and secondary hospitals.=20
Few South African doctors choose, however, to work in =20 our rural hospitals for reasons so exhaustively studied =20 that we need not revisit them here. Suffice to say that =20 neither doctors’ aspirations nor their training fit =20 them for rural service. South Africa’s need for doctors =20 in underserved areas is especially acute in the former =20 “homelands” where health services have been at the =20 point of collapse.=20
Various solutions to this problem have been proposed, =20 including: the revision of undergraduate curricula; the =20 development of medical schools without walls in all =20 provinces; compulsory rural service for graduates; =20 career progression for rural doctors; as well as =20 incentives such as tax relief and forgiveness of =20 student loans. None of these potential solutions has =20 yet been tested or implemented.=20
One way of guaranteeing a planned supply of willing, =20 capable and committed doctors for underserved groups =20 would be for us to copy the approach adopted at Jichi =20 Medical School in Japan. In 1972, despite an overall =20 surplus of doctors, the Japanese Ministry of Health =20 developed Jichi Medical School (JMS) specifically to =20 train doctors for Japan’s underserved regional =20 hospitals and clinics. Jichi Medical School is jointly =20 funded by Japan’s 80 prefecture health authorities =20 (PHAS); Japan’s prefectures are roughly the equivalent =20 of South Africa’s provincial regions. =20
Each PHA sends students to JMS whom they later employ. =20 Students entering JMS do so on the understanding that =20 they will serve for nine years in a regional setting. =20 For their part the prefecture health authorities both =20 subsidise the medical school and guarantee its =20 graduates subsequent employment and career progression. =20 Thus are the students’ needs for a medical education =20 and a career met as are the prefectures’ needs for a =20 planned supply of motivated and competent doctors for =20 their regional services.=20
This imaginative and far-sighted Japanese response to a =20 generic problem besetting many countries is one from =20 which we could learn a great deal. Much would need to =20 be put in place before any such a solution could be =20 attempted here, however. Not the least impediment would =20 be the lack of any collective provincial purpose in =20 South Africa yet. =20
But the idea of a medical school dedicated to the =20 supply of doctors for a particular need is one we could =20 examine because it has immense potential to solve an =20 inherent generic problem. South Africa has many =20 underutilised facilities for the training of our human =20 resources for health which would lend themselves to =20 such a purpose, especially in the future as our =20 tertiary centres are obliged to contract in response to =20 cuts in their budgets.=20
We could thus ensure that all South Africans eventually =20 have access to high quality care provided from health =20 services staffed by motivated and professionally =20 satisfied doctors. Under such a dispensation, doctors =20 could provide a service confident that their =20 professional needs were attended to by responsible =20 regional health authorities able to ensure a supply of =20 doctors for rural service. =20
With an imaginative and bold venture such as the Jichi =20 initiative we could do much to ensure that this =20 country’s needs for quality health care in =20 underserviced areas will, in future, be well met.=20
David Whittaker is a senior lecturer in family medicine =20 at UCT’s medical scool=20