Date Published: July 31, 2017
Author(s): Grace Mburu, Gavin George.
Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges.
This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas.
The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa.
The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis.
Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas.
South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.
Inadequate Human Resources for Health (HRH) has been identified globally as a major hindrance to the delivery of quality health services1. This is a contributing factor to most developing countries’ inability to achieve the health-related millennium development goals2,3 and will undoubtedly factor in the achievement of the sustainable development goals. In Africa, the shortage of HRH is more prevalent in rural areas, which puts an incredible strain on the health care system, resulting in preventable deaths and an increased burden of disease4. This raises concerns, especially considering South Africa has the world’s largest HIV epidemic with an estimated seven million infected individuals5. This high disease burden has placed pressure on health facilities, resulting in the need to increase the health care workforce in order to alleviate the increasing workload, especially in the rural areas6.
Health personnel emphasised the need for government to intervene and improve working conditions in rural health facilities in order to attract and retain staff. The challenges reported by respondents are limited to those that affect the optimal delivery of health services.
In 2011, the DoH launched HRH 2030, a five-year HRH strategy for the health sector6. The strategy recognised the unique HRH challenges facing the rural health sector and identified a number of initiatives aimed at addressing them. These data have confirmed that a number of these initiatives are positively viewed by health personnel working in rural areas. Chief amongst these initiatives is the rural allowance. The implementation of the rural allowance provided an additional 18%–22% of salary for doctors and 8%–12% for professional nurses, which has resulted in creating a significant financial incentive for these health cadres to work in rural areas. However, the rural allowance has come in for some criticism around the classification of rural health facilities, and this has created consternation amongst health personnel. The Rural Health Advocacy Project has argued the importance of determining objectively the ‘rurality and remoteness’ of facilities, which would inform the rural allowance and other incentive-based initiatives19. Only select health personnel cadres receive the rural allowance and this too has created unhappiness amongst health personnel. Literature20 has cautioned that while financial incentives are important, they do not adequately compensate for other, particularly systemic, challenges facing health personnel working in rural areas.
The study details the current challenges facing health personnel working in rural areas and the efficacy of selected government strategies aimed at addressing them. Certain government initiatives have been well received by health personnel working in rural areas in KwaZulu-Natal. Specifically, financial incentives have benefited selected health cadres. Further, the augmentation of health personnel with foreign medical and community service doctors has also alleviated the work load burden. Poor working conditions, lack of supervision and inadequate career progression opportunities remain challenges that require attention.