Publications
HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

Introduction

The maldistribution of health professionals between rural and urban areas in South Africa demands specific strategies to address the imbalance. Financial and non-financial incentives have been used in other countries to recruit and retain health professionals in areas of need, and in 1994 a rural recruitment allowance was instituted in South Africa. However, this allowance was granted only to medical doctors and dentists, and remained at the same fixed rate since the time of its inception. It was perceived to be ineffective as an incentive for retention of professional staff, and despite the introduction of community service for all health professionals except nurses, it remains difficult to recruit and retain professional staff at rural hospitals, health centres and clinics.

The new rural allowance instituted by the Minister of Health is a national initiative that aims to address this problem. The impact of the initial R500 million allocated by Treasury in July 2003 needed to be measured in order to be in a position to objectively evaluate whether it is a worthwhile investment. While the effect of the rural allowance may eventually be seen in staffing patterns of rural hospitals, the longer-term effect is likely to be diluted by the many other factors that influence health professionals career choices apart from financial benefits. It was therefore important that the effect of the new allowance was measured in the short term by direct questioning of those receiving the allowance, in order to control these variables as far as possible, and allow a more direct evaluation of the effect.

However, between the time that the rural allowance was announced in May 2003, and its eventual implementation in March 2004, retroactive to July 2003, there was intense and lengthy debate in the Public Service Bargaining Chamber (PSCBC) regarding the exact nature of this allowance, who it would benefit, and most importantly, who would be excluded. Eventually two separate allowances were agreed upon, the Scarce Skills Allowance (SSA) and the Rural Allowance (RA). The SSA benefits certain categories of health professional (see table) regardless of the place of work, whereas the RA benefits all health professionals in certain health facilities that are designated as rural. The latter areas include the nodes as defined by the Integrated Sustainable Rural Development Strategy (ISRDS), as well as rural areas as designated by the PSCBC based on the previous recruitment allowance. In addition, other so-called inhospitable areas could be determined by provincial Heads of Health, depending on available funds, from within provincial budgets. Negotiations within the PSCBC continue up to the time of writing, and the regulations are being challenged by certain unions.

The changing nature of the allowance made the planning of the research project difficult, in that the data collected for the baseline survey did not anticipate the simultaneous introduction of the SSA, which was confused by some of the respondents and their managers as the RA. Nevertheless, an attempt was made to capture information as the process unfolded, in order to have a baseline on record for future evaluations.