South Africa

Clinical skills and the ability to perform procedures is a vital part of general medicine. Teaching these skills to aspiring doctors is a complex task and it starts with a good theoretical preparation and some practical experience at university. On graduating from university, each doctor is faced with the task of transforming theoretical knowledge into the practical, procedural skills of a competent professional. This study aims to assess the perceptions of intern doctors working in regional hospitals in the Western Cape of their skills training both at undergraduate level and during the intern year.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It details a study done to assess the feasibility and interest among stakeholders in the Netherlands, UK and US in facilitating recruitment and placement of foreign health care professionals to work in public sector health care in South Africa. [adapted from author]

The general aim of this paper is to add to the limited research on family caregivers, and specifically to enable a better understanding of the actual experience of providing care for ill adults within the home in the context of HIV/AIDS, using qualitative research findings from a KwaZulu-Natal study. [from author]

This study evaluated the skills and competency levels of hospital managers in South Africa to determine whether there are any significant differences between managers in the public and private sectors. The results show that managers in the private sector perceived themselves to be significantly more competent than their public sector colleagues in most of the management facets. Public sector managers were also more likely than their private sector colleagues to report that they required further development and training. [adapted from abstract]

It has been shown that, internationally, medical students of rural origin are more likely to practice in a rural area after graduation, but this has not been demonstrated in South Africa before. This study aimed to investigate the career choices of medical graduates of rural origin in the South African context, and to determine what proportion of rural origin students are currently practicing in a rural area. [from abstract]

The objective of this study was to quantify staff requirements in primary health care facilities in South Africa through an adaptation of the WHO workload indicator of staff needs tool. The results show that the application of an adapted WHO workload tool identified important human resource planning issues. [adapted from abstract]

In order to highlight the driving forces determining the international allocation of medical personnel, the cases of four countries (the Philippines and South Africa as source countries, and Saudi Arabia and the United Kingdom as destination countries) are examined. The paper concludes that changes in demand generated in major destination countries determine the international allocation of medical personnel at least in the short run. [from abstract]

This edition focuses on the role of the private sector, a part of the health system that has not previously been accorded extensive coverage in the SAHR. The contrast between the public and private sectors remains stark in many facets and the deepening inequity is cause for profound concern. The significance of the private sector cannot be underestimated both with regard to its potential contribution to the health and well-being of this country’s people, as well as its role in drawing resources (financial and human) from the public sector.

The nurse is the single most important frontline health worker. Without nurses the clinics, community health centres and hospitals cannot function. It is therefore critical that nurse education and the supply of nurses form an integral part of transformation of health services in South Africa. According to the Department of Health there is a need to significantly increase the production of all categories of nurses in order to fulfil the requirements of South Africa. Attracting new recruits to the profession is an integral part of increasing production. It is for this reason that a study was undertaken to assess the attitudes of school leavers towards taking up nursing as a profession, and the reasons for these attitudes.

The objectives of the study were to assess the extent to which CHW deployment has been addressing important health priorities; document success stories and lessons, identify champions; understand the range of ways that CHW programmes have evolved in South Africa and compile recommendations and lessons learned to improve practice. [from executive summary]

Health care providers play a crucial role in determining access to reproductive health services and their influence is likely to be heightened in delivering services to HIV-infected women. We examined the attitudes of health care policy makers and providers towards reproductive decision- making among HIV-infected individuals. [from abstract]

Nurses provide the bulk of primary care services in South Africa. Post-apartheid health legislation envisions the provision of comprehensive primary services at all public clinics, which implies the need for a cadre of primary care nurses able to render such services. The objective of this study was to identify core competencies of clinic nurses and develop an evaluation tool for primary care nursing in South Africa. [from abstract]

Family Medicine training and assessment is becoming more formalized and developed in South Africa. Assessment of competency in relation to clinical skills can involve observation in the clinical setting, but is more usually assessed in an examination. Summative assessment of family physician’s clinical skills now usually includes an Objective Structured Clinical Examination (OSCE). Standardisation of the OSCE is required to define the pass mark above which a candidate performs at the level expected of a family physician. [from abstract]

Both financial and nonfinancial factors influenced the tenure and job satisfaction of nurses at public maternity services in South Africa. Surveys suggest that strong management and fully equipped facilities could help redress staff turnover. [author’s description]

While the availability and use of trained midwives can shape the quality of care received in pregnancy and childbirth, a number of other underlying health systems structures and processes are important. The management of health workforces, the mix of public and private provision and the impact of reforms affect quality of care across countries…[This study] examined how the structure and operation of a health system influences maternal health care provision and outcomes in Bangladesh, Russia, South Africa and Uganda. [author’s description]

South Africa has a serious shortage of human and financial resources to provide primary healthcare services especially in the historically under-served areas. It is a tedious task to carry out healthcare delivery for the masses without rationalizing human resources in the form of re-allocation and re-deployment of healthcare personnel. This study aimed to establish the level of adequacy and efficiency of nursing staff in the former Transkei region. The study was carried out in the child and family welfare clinic of the Umtata General Hospital. [from abstract]

Occupational stress and burnout merit concern in South Africa as the severity and intensity of the HIV epidemic is often perceived as overwhelming, leaving many caregivers with intense feelings of hopelessness and despair. This study explores and describes the experiences, feelings and perceptions of South African caregivers working in various capacities (healthcare, counselling and teaching) in the HIV/AIDS field. [from abstract]

Achieving the health Millennium Development Goals will require a significant scaling up of health service delivery in many countries. The number of competent managers will also have to be scaled up at the same time – managers are an essential resource for ensuring that priority needs are met and resources are used effectively. This study describes various management strengthening activities in 3 countries – South Africa, Togo and Uganda. [from executive summary]

The objective of this study was to assess whether adding a training intervention for clinic staff to the usual DOTS strategy (the internationally recommended control strategy for tuberculosis (TB)) would affect the outcomes of TB treatement in primary care clinics with treatemet success rates below 70%. [from abstract]

This report outlines information from a literature review and field research pertaining to the key differences and similarities between the hospice ICHC model and other home-based care models used in South Africa; reviews the core elements of the ICHC model; and highlights best practices of the model. [adapted from introduction]

The development of the delivery of reproductive health services is continually confronted by challenges from a changing environment, an important element of which is health sector reform, in particular decentralization, which is being undertaken by most governments in Africa. The general objective of this research is to make health sector decentralisation more effective in the development of appropriate reproductive health services. In Chapter 8 human resource management and development as it has been affected by decentralization is discussed. [adapted from introduction]

The goal of this policy is to help management and staff minimize the risk of TB transmission in health care facilities and other facilities where the risk of transmission of TB may be high due to high prevalence of both diagnosed and undiagnosed TB such as prisons.

This report focuses on the impact of human resource shortages witnessed by MSF teams in four southern African countries - Lesotho, Malawi, Mozambique, and South Africa. While the focus is largely on nurses in rural areas, it should be acknowledged that health staff is lacking across the spectrum - from doctors to laboratory technicians to pharmacists - at all levels of care. In all these cases the need for access to ART, as well as other health needs, is outstripping human resource capacity. [from introduction]

The effective provision of health services in poor countries is severely hampered by lack of staff. A frequently cited reason for staff shortages is brain drain or moving to greener pastures. Although international migration of health personnel has been occurring since before the 1970s, this has been further facilitated by the recent globalisatioIl of markets and the development offree trade agreements. A summary of an international review was done, to place the South African situation within the international context, and understand the various factors that influence migration. [from executiv

South African citizens have experienced many inequalities and these have extended to the health care setting. one of the major challenges that needs to be addressed is the accessibility and availability of health care and specialized medical services in rural areas in South Africa. Telemedicine is a potential solution to address some of the challenges within health care in a developing country like South Africa. This article looks at the experiences of developing and implementing a telemedicine solution. [abstract]

Effective teamwork between doctors and clinical nurse practitioners (CNP) is essential to the provision of quality primary care in the South African context. The Worcester Community Health Centre (CHC) created dedicated practice teams offering continuity of care, family-orientated care, and the integration of acute and chronic patients. The teams depended on effective collaboration between the doctors and the CNPs. This inquiry focuses on the question of how more effective teams of doctors and clinical nurse practitioners offering clinical care could be created within a typical CHC. [adapted f

This chapter aims to determine the current demand for medical practitioners and nurses in South Africa by looking at the number of positions that are filled and the number that are currently vacant. It attempts to determine the number of medical practitioners and nursing positions that will be required until 2011, establishes the expected output from higher education over the next ten years, and determines the gap between supply and demand of health professionals. [adapted from introduction]

The 2006 Review seeks to provide a South African perspective on prevailing international public health issues, and in particular provides an opportunity to reflect on progress to achieving the Millennium Development Goals many of which are linked to maternal and child health. It also seeks to stimulate debate and critical discourse, to provide a platform for assessing progress and to identify key gaps and opportunities for future action that is realistic and sustainable. [from foreword]

This presentation details a program to implement and evaluate the feasibility, acceptability, effectiveness and cost of two models of integration of HIV prevention information, and routine offer of provider initiated counselling and testing for HIV into family planning (FP) services in 18 health facilities in North West Province, South Africa. [adapted from abstract]

The purpose of the study is to obtain information on the level of workplace violence in the health sector in South Africa. In particular this study examines the extent of workplace violence, factors that may contribute to violence and explore the most suitable strategies and appropriate policies to prevent and address violence in the workplace. [introduction]