The impact of national strategies in addressing challenges faced by human resources for health in rural KwaZulu-Natal.

Abstract

The shortage of Human Resources for Health (HRH) is critical in developing countries. In South Africa, the capacity of HRH has reduced significantly since the 1990s, which can be attributed to e.g. emigration of health professionals to developed countries, increased disease burden, and insufficient production of HRH. This raises concerns as South Africa is home to the largest population of people living with HIV globally, estimated at 5.7 million. The distributions of HRH between urban and rural areas are notably uneven, largely due to problems of attracting and retaining workers to the rural areas. It is estimated that 46% of the population lived in rural areas but are only served by 12% of doctors and 19% of nurses. Furthermore, the shortage of HRH in the rural areas is as a result of the challenges faced by the HRH in the rural areas namely: poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities among others. The Government has come up with several policy initiatives and National strategies aimed at addressing these challenges including community service, recruitment of foreign doctors to work in under-served areas, provision of rural allowance, and the Occupational Specific Dispensation (OSD). This study sought to determine the challenges faced by HRH in rural KwaZulu-Natal (KZN) and to review the impact of National strategies in addressing these challenges. The study is based on the talent management theoretical framework which emphasizes on adopting the right attraction, selection, engaging, developing, and retention strategies. The study was conducted in Hlabisa sub-district of Umkhanyakude located in northern KwaZulu-Natal. Cluster sampling was used to select 17 clinics into 3 groups. A random sampling was then used to select the two clinics from each cluster to be used in the study. Data was collected by conducting in-depth individual interviews among 25 HRH. A tape recorder was used to capture data, which was then analysed by highlighting the key statements which were used to identify themes. The themes for each interview were then compared to identify commonalities and differences in order to come up with overall themes which provided basis for writing up how these respective themes are interrelated. v The findings of the study provide evidence on the impact of policy interventions in addressing the challenges faced by HRH in rural areas. In line with previous studies, the study shows that national strategy initiatives aimed at addressing the challenges faced by HRH in the rural areas are working but only to a certain extent. For example the health professionals are happy with the implementation of OSD, which means the government has adequately addressed the issue of salaries. The community service and recruitment of foreign doctors to work in rural areas is partially addressing the problem of staff shortage. However, some of the specific challenges like the poor working and living conditions which greatly contribute to the HRH decision to leave the rural areas do not have specific strategies addressing them. Therefore, there is need for a more comprehensive approach in the formulation of these strategies to ensure that the challenges are addressed adequately. Our study highlights the need for a constant review of the impact of the Government strategies against the challenges they are designed to mitigate to ultimately address shortage of HRH in rural areas. Some of the study limitations include: limited literature on the topic since there are very few evidence based studies that have looked at how national strategies are impacting on the challenges of HRH in rural areas. the talent management theoretical framework was adopted in the absence of a more appropriate framework on management of scarce skills, and the study was conducted in one of the sub-districts in KZN which might limit its generalisability to other settings.