Recruitment and retention of optometrists in the public sector of KwaZulu-Natal.

Abstract

Introduction With Africa sharing just under a quarter of the world’s disease burden, there is a limited and disparate distribution of health workers to meet this challenge. In public sector optometry, the situation is no different from the sub-Saharan scenario. In South Africa, there is a vibrant private sector catering for the privileged few while there is a paucity of optometrists serving the larger public sector. KwaZulu-Natal is one of the most densely populated provinces and home to several of the poorest districts in South Africa. Despite an optometry school in the province, and with the lack of compulsory community service for new graduates, there is still a dire need for optometrists to serve in the public sector. Recruitment of appropriate health workers takes into account demographic, educational and socio-economic factors, while retention requires the input of several financial and non-financial components to keep staff motivated and productive. Aim The aim of this study was to investigate recruitment and retention elements that would appeal to and retain present and future optometrists in the public sector. Methods A cross sectional methodology, gathering both quantitative and qualitative data, was used. All public sector optometrists and district co-ordinators in KwaZulu-Natal province were contacted, with an 80% (41 out of 51) and 75% (9 out of 12) response rate received respectively. For optometrists and district co-ordinators, a questionnaire containing demographic, recruitment, retention and open ended questions was distributed by post, fax, email and online survey. For both groups, telephonic interviews were conducted using semi-structured techniques, allowing for triangulation of quantitative responses. Frequency distributions, Fisher’s exact test and Odds ratios were used to describe associations between demographic data and recruitment and retention queries. Qualitative responses were recorded, transcribed and then coded for recurring themes. Results The present public sector optometry workforce comprises mainly young (73%), Black (70%), females (66%). They chose to work in the public sector to ‘make a difference’, and was also attracted by ‘good working hours’ and ‘job security’. Fifty three percent of the sample chose to work in the public sector due to a study bursary, for which there was a statistically significant association for race (p = 0.01), gender (p = 0.05), and background origin (p = 0.05). To aid their retention in public service: improved salaries, career progression, recognition by supervisors, improved management relations and improved equipment was highest ranked. From the district co-ordinator’s perspective, recognition, improved salaries, career progression and improved equipment and infrastructure are imperative to retain optometrists. District co-ordinators also pointed out that a devolved health system places more managerial and financial autonomy at the level of the hospital management which can cause delays in career progression and procurement of equipment. Discussion The demographic profile of the currently serving public sector optometrists poses many human resource challenges and opportunities. While universities have selected students to better redress past inequities in higher education, there still appears to be a lack of representation of white and coloured optometrists in the public sector. Marketing of the profession of optometry needs to be done by innovative methods over and above mainstream media, to be more attractive to rural candidates. From the Department of Health’s perspective, the provision of study bursaries is the prime method to increase optometrists in health districts. At the same time, however, it creates a multi-generational mix of health professionals (Millennials and Generation X’s, in this sample) with each requiring their own unique retention interventions and methods of workforce motivation. Review of salaries and advocacy for comparable salaries requires attention if the Department of Health wishes to retain optometrists with financial incentives. More engaging and responsive human resource management systems are needed at the hospital level to better articulate career progression for professionals. Processes for the efficient procurement of equipment are imperative to not only retain optometrists, but also to provide quality service delivery. From a District Co-ordinator’s perspective, despite decision making powers existing at the institute level, there needs to be regular, transparent communication and discussion of plans for better synergy between hospital management, optometrist and district office. Conclusion Universities appear to recruit a representative proportion of optometrists, but more attention needs to be paid to rural origin and prior exposure of candidates. Departments of Health use a study bursary incentive to recruit health workers, but much consideration needs to be given to financial (salaries comparable to other allied health professionals, rural allowance) and non-financial incentives (career pathway development, recognition by management, equipment and infrastructure) to retain optometrists. Emphasis needs to be placed on human resource management at hospital level, with clear and well-articulated programme planning and budgeting shared with all.