Problem: What problem is this project trying to address?
The shortage of healthcare workers is biggest challenge facing public healthcare in South Africa today. Seventy percent of the country’s doctors work in the private healthcare sector, which serves only 16 percent of the population. The implication being that the remaining 30 percent of South Africa’s doctors work in public healthcare, which serves 84 percent of the population. This situation is further exacerbated by the high concentration of public sector doctors in urban areas. Consequentially, the shortage in healthcare workers is most severe in rural areas where 43.6 percent of the country’s population lives but only 12 percent of doctors and 19 percent of all nurses work. This means that there are 13 doctors and two specialists available for every 100,000 people without medical aid in South Africa’s rural areas. With 22.3 million of the nation’s population living in rural areas, this translates to one general practitioner for almost every 8,000 people (South African Health Review, 2011). In some cases, vacancy rates at rural hospitals are as high as 50 to 60 percent.
Rural communities often face considerable health challenges due to overall social and economic conditions in these areas. Most inhabitants do not have access to electricity or piped water, and live in scattered homesteads, living on subsistence farming supplemented by income from pensions, grants and wages from migrant labour. Malaria, tuberculosis, and HIV/AIDS are examples of the major health problems affecting these rural communities, while the lack of clean water and inadequate sanitation results in poor hygiene leading to health problems such as gastroenteritis and parasitic infestations. Chronic poverty and illiteracy further lead to widespread malnutrition. The enormous staff shortages in the rural healthcare system certainly have an impact on the quality of care offered to patients and restrict the ability of even the few rural health workers to address these health problems. Doctors and nurses are overworked and burnt out, causing reduced retention rates and decreasing the quality of care they can deliver.
South Africa produces about 1,300 doctors yearly but only 35 of them end up working in rural areas in the long term. According to the South African Health Review (2011), there are many reasons why healthcare workers do not want to work in rural areas, including the poor working conditions (infrastructure and workload) and professional and personal isolation, which have a major impact on retention rates of doctors. The government attempts to address this problem by employing foreign doctors and health professionals to work at these rural hospitals. However, stringent immigration regulations only allow these doctors to work in the area for a specified period of time (12 months). Importing foreign doctors is an ineffective solution to the shortage because of this short period of stay, limited knowledge and experience of local diseases, lack of understanding of local tradition and culture as well as language barriers.
The real key to solving this problem is surprisingly overlooked. It has been proven that rural students themselves, or those exposed to rural healthcare, are four to seven times more likely to return and work in rural areas after graduating (University of Stellenbosch) but surprisingly few do. In countries such as Australia, for instance, state subsidies to medical schools are dependent on them offering a rural clinical training module. But in South Africa, the government’s only requirement of its young doctors is that they do a year's community service after their two-year post-graduation internship, which doesn’t solve the problem of long-term retention. The lack of connection for graduating doctors to rural communities lowers retention, since their only point of connection to the rural communities is the one year community service. There are no other interventions that recruit young people right from the communities and train them to serve their communities. These young people are an untapped resource because they are already connected to problems, challenges, language and culture of the communities they grew up in and would understand that they are entrusted by the community to serve the community.
Therefore, while the key may be to train more students from the rural areas to become health professionals and then assist them in finding work in rural settings, rural youth are precisely the segment of the population that has fewer opportunities to access medical training and employment. In fact, youth unemployment, which is already rampant in the country, is even higher amongst rural youth, reaching up to 80 percent of the population in some provinces. Even for those who manage to complete school, there are virtually no opportunities for them to access tertiary education (due to their grades and financial situation), let alone in a health-related field. Thus, young people from rural areas lack access to opportunities to become healthcare professionals due to financial constraints and would never dream of pursuing such a path due to a lack of exposure, career guidance and role models they can relate to.
Solution: What is the proposed solution? Please be specific!
Andrew, a general practitioner working as a hospital supervisor in the rural areas of KwaZulu-Natal province, was confronted with the critical shortage of medical professionals in rural South Africa when he needed to staff his team. Andrew’s insight is that people from rural areas are better positioned to serve their communities, especially in the medical field, due their inherent understanding of societal dynamics and their existing sense of connection to place. However, most youth in rural areas lack education and employment opportunities and this denies them permission to dream big and pursue a medical career. In order to address this, Andrew developed a program that recruits young people in rural areas and exposes them to higher education training and employment opportunities in the medical and health-related fields. Through a comprehensive selection process, interested and passionate young people are selected into the program and are offered full scholarships through university and assisted with placement in rural hospitals upon graduation.
Andrew works to enhance the participants’ confidence and strong connection to their communities through mentorship and community service programs run by his organization, Umthombo Youth Development Foundation (UYDF). Andrew’s objective is to develop homebred young medical professionals who embrace their careers as a calling to serve their communities rather than just a source of income. UYDF has established close relationships with local hospitals to assist with student selection and most significantly to allow students to work at the hospital during the holidays and offer employment after graduation. Since its formation, the scholarship program has been a source of hope for rural scholars and given them something to aim towards. It has also created role models for young people still in school. Students at local schools can see and talk to other scholars who went to similar schools and have succeeded in their professional lives. This enables those students still in school to dream that they too might become health care professionals in the future.
To date, Andrew has trained and retained 185 health professionals in 13 different hospitals in the rural areas of KwaZulu-Natal and Eastern Cape, who have all completed full medical, or health-related higher-education training and practice (residency). Currently, 200 students are supported every year in 16 health disciplines. Andrew is now planning to scale out to other provinces in South Africa facing similar problems. By 2016, he plans to increase the intake to manage about 250 youth per cycle in the program. Furthermore, Andrew seeks to share the model with provincial Departments of Health and influence them to adopt what he considers to be the “critical aspects” of the program. It is hoped that this sharing of information will influence the provincial Department of Health’s policies on selection and support of rural students and will lead to greater throughput of rural students and greater work back compliance – both of which will contribute to addressing the shortages of staff at rural hospitals. In addition UYDF has been able to incorporate government-subsidized student loans as scholarship offers for rural students and hopes to expand this at a national scale. He is also creating new post-graduate training programs that ensure ongoing professional development as a way to improve the quality of the service but also to ensure high retention rates of medical professionals in rural areas.