The recruitment and retention of medical practitioners and specialists in rural areas : the case of the North West Department of Health

Abstract

The study focused on the recruitment and retention of medical practitioners and specialists in the rural areas of the North West Province. Given the constitutional requirement to provide quality health care services to all citizens, and in consideration of the National Development Plan (NDP): Vision for 2030 (2011), highlighting the failing public health care system in the country as one of the most significant challenges of the democratic developmental state, it is evident that the public health sector needs to recruit and retain skilled, capable and competent medical employees to ensure that the Government delivers on its constitutional and service delivery mandate and to ensure the achievement of the goals and objectives of the democratic developmental sate. However, the Public Service continues to experience challenges in recruiting and retaining employees with scarce skills (RSA, 2008a:45; RSA, 2011a:371; RSA, 2012:334), especially medical employees (Labonte et al., 2015:2; Bergstrom et al., 2015:307; Rural Health Advocacy Programme, 2015:1). In addition, the majority of the population (84.5%) in the North West Province’s rural areas are dependent on public health care (STATS SA, 2017:24, McIntyre & Ataguba, 2016:9). In spite of this need, the majority of medical practitioners (53%) and specialists (90.1%) are employed in the urban areas, leaving the public health sector understaffed to effectively provide in the people’s health care needs. Further to this, the North West Department of Health (NW DoH) has an employee turnover rate of 50.1% for medical doctors and 31.4% for medical specialists (RSA, 2017a:156). The aforementioned context and challenges led to the identification and formulation of the research problem: the NW DoH does not employ an adequate number of medical practitioners and specialists to serve the population of the North West Province; thereby, not effectively fulfilling its mandate to provide quality health care services to citizens and should thus enhance its recruitment and retention strategies to recruit and retain medical practitioners and medical specialists, especially in rural areas. To address the research problem, a theoretical framework for employee recruitment and retention in the Public Service was established in Chapter 2. In Chapter 3, the statutory and regulatory framework pertaining to the recruitment and retention of medical practitioners and specialists was reviewed, as well as a statutory and regulatory framework for the public health sector. Following the literature review and the review and the statutory and regulatory framework, an empirical investigation was conducted (Chapter 4). A self-administered semi-structured questionnaire and the semi-structured personal interviews were used as data collection instruments. The study followed a mixed method approach, descriptive research design and purposive, non-probability sampling. The questionnaire was completed by medical practitioners and specialists and the personal interviews were conducted with the human resource management (HRM) practitioners; the CEOs of public hospitals; and a Clinical Manager. The questions of both the questionnaire and interviews focused on the recruitment and retention of medical practitioners and specialists at the NW DoH, especially at rural areas. The findings from both the questionnaire and interviews revealed the following themes as significant to the recruitment and retention of medical practitioners and specialists in the NW DoH at rural areas: continuous professional development; career development; mentoring, coaching and supervision; additional financial benefits working conditions; the availability of equipment and supplies; living conditions; municipal infrastructure; and access to good schools. Subsequently, a number of recommendations were made with a view to increase the recruitment and retention of medical practitioners and specialists in the North West Province, especially in rural areas. The recommendations indicated that the following aspects should receive attention by the NW DoH in regards to the recruitment and retention of medical practitioners and specialists: good working conditions; appropriate accommodation and living conditions; career development and continued professional development opportunities; mentoring, coaching and effective and supportive supervision; the payment of financial incentives, additional to the rural allowances; changes in the scope of practice; the failure of the OSD; and a strategic integrated HRM approach.