Community service for doctors in South Africa was conceived amid controversy, but has emerged as a symbol of the commitment of the health department and the medical establishment to equity in the health system, according to the SA Health Review.

But a concern remains the fact that unclear policy guidelines in the first year of implementation lead to only 259 (less than 25%) of the community service doctors being placed in rural hospitals, while 55% were working in regional, tertiary and specialised hospitals.

“The aim to distribute health personnel throughout the country in an equitable manner has only been partially addressed by this policy so far,” said authors Steve and Daphney Conco.

Released by the Health Systems Trust, the SA Health Review is published annually and is primarily aimed at policy makers, planners and managers in the health sector.

The Review represents a combination of commissioned research, experience and available published literature with a specific focus on equity.

Reid said preliminary findings indicated that the aim of ensuring improved provision of health services to all citizens of this country had probably been met.

All the health facilities that received community service doctors reported positive impacts, except for one tertiary hospital that regarded them as a nuisance.

Major issues identified by the community service doctors included supervision and support, learning and attitudes and coping skills.

The level of supervision available to community service doctors was variable. In teaching hospitals, first year medical officers were given very little opportunity for independent decision-making. In isolated rural hospitals community service doctors were often the only full-time medical staff.

Most doctors reported that they had learned to make independent decisions for the first time. Most learning was in the area of gaining confidence and insight into themselves as practitioners.

The realisation of many doctors that they were actually making a difference was a huge motivation for them. This was particularly so for those who visited outlying clinics, some which had never been visited by a doctor.

The development of self-confidence was also a critical factor in maintaining a positive attitude to the year.

In terms of impact, the smaller hospitals felt it more that the bigger hospitals.

Most of the information below applied to smaller hospitals:

Stress relief for other doctors and nurses doing fewer calls;

Well staffed hospitals;

Less crowding in the outpatients department;

Fewer lodgers in the wards;

Faster turnover of patients in the wards;

Outlying clinic visits;

Development of skills;

Transfers to other hospitals;

Communication improved with doctors able to speak the local language;

Enthusiasm.

Reid said government needed to ensure that some of the community service doctors could be retained in the public sector. ‘€“health-e news service.