Compulsory community service could be worsening rather than reducing the tendency of young doctors to leave SA, a newly published study concludes.
The study, in the latest issue of the SA Medical Journal, found that a third of doctors surveyed intended to seek employment outside SA after completing their year of community service.
Its author, Dr Steve Reid of the University of Natal's Centre for Health and Social Studies, said this was disturbing. He said one of the implicit aims of the health department in introducing community service had been to slow the exodus of young SA medical graduates to greener pastures overseas.
It would appear that community service has no effect on the career plans of the doctors, but merely delays them by a year, Reid said. This brings into question the long-term effects of community service, which may even be exacerbating rather than lessening the tendency of young doctors to leave the country, he said.
The survey on which the findings are based was conducted at the end of 1999, the first full-scale year of community service.
Health Minister Manto Tshabalala-Msimang's policy of community service has been praised in the past by David Mametja, director of the Health Systems Trust, who called it a success story that brought doctors to clinics in small towns and rural areas for the first time.
Reid said the department's main aim of ensuring better health services to all South Africans was most probably being met by the
programme. All health facilities surveyed that received community service doctors reported positive effects, except for one tertiary hospital that regarded them as a nuisance.
The secondary aim, to give young professionals a chance to develop skills and acquire knowledge, had applied to some but not all of the community service doctors. Those in rural hospitals felt relatively disadvantaged in terms of clinical supervision, opportunities to study and psychological coping.
In general, however, the response of community service doctors to the challenges and difficulties in public service hospitals around the country had been encouragingly positive, particularly in terms of
The realisation by many community service doctors that they were actually making the difference in the communities they were working in had been a huge motivation.
A minority found their environment demoralising, and felt resentful at the unfairness of the allocation process that placed them where they were.
Reid recommended that a comprehensive human resource policy be developed for the distribution of medical personnel, plus an explicit strategy for meeting medical needs in rural and underserved areas of the country.
Reid said it was important to acknowledge the training component of community service.
SAPA, 25 April 2001