Pule waga Mabe
The shortage of doctors in most rural hospitals is a growing concern within the
ranks of the Rural Doctors’ Association of South Africa (Rudasa), which is now
calling for the national Department of Health to establish a rural health unit.
Rudasa’s concern follows the failure of compulsory community service for doctors
to make a meaningful contribution in the most short-staffed hospitals in the
country.
“Community service for doctors has improved the situation in some provinces, but
two serious shortcomings of the scheme are becoming apparent the lack of senior doctors to supervise and the fact that only a quarter of doctors are allocated to rural hospitals,” says Dr Steve Reid of Rudasa.
Reid says the most needy hospitals in the country appear to be avoided by community service doctors in their choices.
“There is [more] social exposure in urban areas than there is in rural areas,”
he says. He says working conditions in rural hospitals breed unhappiness because
of the lack of infrastructure. However, Reid says, that should not excuse the
lack of provision of professional services to those most desperately in need of
doctors.
In its position paper on the situation, Crisis in Staffing of Rural Hospitals,
Rudasa calls on the Department of Health to revise the allocation process for
community service to ensure that rural hospitals receive doctors before posts in urban hospitals are filled.
Rudasa says the department should also review recruitment procedures and working
conditions of doctors who are prepared to commit themselves to longer terms in
rural practice.
“Those community service doctors who show an interest in pursuing a career in
rural medicine need to be encouraged by appropriate incentives or bursaries for
further study,” the position paper says.
Reid says the worst-affected provinces are the Northern Province and Eastern
Cape.
The Northern Province has 136 community service doctors and the Eastern Cape has
110, with the KwaZulu-Natal topping the provincial list with 248 doctors. The
North West accounts for 80 community service doctors, Free State has 74, Mpumalanga has 106, Northern Cape has 31, Gauteng has 127, the Western Cape has
133 and the South African Military Health Service has 39.
Reid says that of 1 173 applications received for community service in 2001, 83%
were largely placed in urban hospitals.
Rudasa recognises the input from foreign doctors, but it has reservations apart from cultural and language differences about the recruitment of Cuban
doctors for rural hospitals. “Since Cuban doctors are trained as specialists,
their lack of general skills makes it difficult for most Cubans to handle the
wide scope of rural practice in South Africa,” says Rudasa’s position paper.
Charles Nkadimeng of the Northern Province Department of Health says the province is developing a policy on incentives for doctors working in rural areas. “Some areas don’t have cellphone signals, making it hard to attract skilled personnel.”
Nkadimeng says the province is investing in improving infrastructure in rural
areas as a priority.