Placement, support, and retention of health professionals: national, cross-sectional findings from medical and dental community service officers in South Africa
Open accessAbstract
Background: In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Community service officers are required to contribute a year towards serving in a public health facility while receiving supervision and remuneration. Although the South African community service programme has been in effect since 1998, little is known about how placement and practical support occur, or how community service may impact future retention of health professionals. Methods: National, cross-sectional data were collected from community service officers who served during 2009 using a structured self-report questionnaire. A Supervision Satisfaction Scale (SSS) was created by summing scores of five questions rated on a three-point Likert scale (orientation, clinical advising, ongoing mentorship, accessibility of clinic leadership, and handling of community service officers’ concerns). Research endpoints were guided by community service programmatic goals and analysed as dichotomous outcomes. Bivariate and multivariate logistical regressions were conducted using Stata 12. Results: The sample population comprised 685 doctors and dentists (response rate 44%). Rural placement was more likely among unmarried, male, and black practitioners. Rates of self-reported professional development were high (470 out of 539 responses; 87%). Participants with higher scores on the SSS were more likely to report professional development. Although few participants planned to continue work in rural, underserved communities (n = 171 out of 657 responses, 25%), those serving in a rural facility during the community service year had higher intentions of continuing rural work. Those reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities. Conclusions: Despite challenges in equitable distribution of practitioners, participant satisfaction with the compulsory community service programme appears to be high among those who responded to a 2009 questionnaire. These data offer a starting point for designing programmes and policies that better meet the health needs of the South African population through more appropriate human resource management. An emphasis on professional development and supervision is crucial if South Africa is to build practitioner skills, equitably distribute health professionals, and retain the medical workforce in rural, underserved areas.
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A detailed study of the 2009 cohort of community service doctors developed a supervision satisfaction score and found a high level of participant satisfaction with community service.
“Using the same data, a detailed study of the 2009 cohort of CS doctors developed a supervision satisfaction score (SSS) and found a high level of participant satisfaction with CS. [17]”
From Compulsory community service for doctors in South Africa: A 15-year review (2018) · cites this paper as [17]
The Methods (Data collection) say the study created a Supervision Satisfaction Scale from five items, and the Results report high ratings on several aspects of the 2009 community-service experience. But the sample included dentists as well as doctors, and the Results show mixed satisfaction rather than uniformly high satisfaction with community service: only 50% said management handled concerns well, and 34% reported no risk to personal safety. (LLM, conf=0.87)
Experimental — accuracy not yet measuredParticipants reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities.
“The authors noted that participants reporting professional development during the CS year were twice as likely to report intentions to remain in rural, underserved communities.”
From Compulsory community service for doctors in South Africa: A 15-year review (2018) · cites this paper as [17]
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- Authors
- Hatcher, A. M., Onah, M., Kornik, S., Peacocke, J., & Reid, S.
- Affiliations
- University of the Witwatersrand (ZA)
- Corresponding author
- Peacocke, Julia
- Venue
- Human Resources for Health
- Published
- 2014-02-26
- Volume
- 12
- Issue
- 1
- Pages
- 14-14
- ISSN
- 1478-4491 (ISSN-L)
- PMC
- PMC3975958
- OpenAlex
- W2141867583
- Cited by
- 53
- References
- 31
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 7 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 8 · 2018: 8 · 2017: 9 · 2016: 1 · 2015: 1
- FWCI
- 6.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Human Resources for Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
- Funders
- United States Agency for International Development
- U.S. President’s Emergency Plan for AIDS Relief
- Department for International Development
- Inyuvesi Yakwazulu-Natali
- University of Cape Town
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Health Professions › General Health Professions › Health and Medical Education
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Keywords
- community service, health workforce retention, rural health workforce, professional development, clinical supervision, mentoring, placement, dentists, physicians, rural underserved communities, health workforce distribution, South Africa
- MeSH terms
- Workforce, Adult, Community Health Services, Cross-Sectional Studies, Dentistry, Dentists, Female, Humans, Male, Physicians, Surveys and Questionnaires, Rural Population, Social Welfare, South Africa, Logistic Models, Rural Health Services, Intention, Black People
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