An initiative in the Western Cape shows that the challenge of retaining health workers in rural facilities can be overcome. After unsuccessful attempts by Tygerberg Hospital to recruit and retain health workers, the hospital decided to create an interest in the health profession among people living in its surroundings of the Boland region. The hospital saw the need to open a nursing college in the area after many were closed down in the mid 90s. Helise Schumann, who co-ordinates the activities of the college, shares some of the college’€™s successes.

‘€œAbout 70% of all nursing staff in the Boland area – that’€™s about 800 nursing staff – 70% of them have been trained through our school. We’€™re a hospital that makes use of no agency nursing staff – one of a very few in the Western Cape. On a bad day, our nurse vacancy rate for nursing staff is about 1.5%, and I think that’€™s pretty good.

We also make use of a step-ladder approach; we first started with training our own staff like cleaners, porters, food services aid and laundry staff. We gave them training to become nursing assistants’€.

Schumann says the training college not only benefits Tygerberg Hospital. Neighbouring facilities, like Worcester and a number of district hospitals owe their staffing levels to the nursing college. She says the college follows a strict selection process when recruiting candidates.  

‘€œUsually, at the beginning of the year we do a needs analysis for Worcester Hospital and for the district hospitals – look at what their needs are – and that’€™s around January or February in the year. By July we place ads in the local newspaper for Worcester Hospital and the district hospital, we then do a paper selection. After that the successful candidates go through a literacy and numeracy test’€.

 ‘€œWe get local community leaders in as partners in the interviewing process. The level of trust is so high that the community leaders leave it up to us to select. The final selection is made in October of the year and the new students start the following year’€, she says.

The nursing college trains up to 100 students per year.  It targets unemployed people and school leavers.

Besides the shortage of nurses, doctors are also in short supply in rural South Africa. The Africa Health Placements (AHP) seeks to address this shortage.

It does this by recruiting and placing medical students in health facilities in rural areas with the hope of retaining them for a longer period of time. But the organisation’€™s Chief Executive, Saul Kornik, says it is hard to attract South African medical students to rural communities.

As a result, he says the majority of their placements come from foreign countries. ‘€œWhat we are finding in terms of bringing health workers from a private sector into a public sector or move them from urban to rural areas, are that they cite management as the reason they don’€™t want to work in rural areas and why they don’€™t want to work in government hospitals. This needs to be addressed immediately because we cannot convince them to move into rural areas. The only guys we are able to get in there are from overseas and are here for 2 or 3 years and are not too invested in the system. We would prefer to have our own locals there’€, says Kornik.

Due to this, the quality of health care in rural health facilities is compromised. Added to that are systemic problems such as long queues. Patients often have to travel far distances to reach the service.

 ‘€œThe feed-back that is coming through from our doctors and nurses is that the patients are grateful for the service they are receiving, but are presenting themselves very late. They are often far down in their various illnesses, and coupled with inadequate resources, the health workers are not able to do as much as they would had the patient come at an earlier date and had more resources been available’€, explains Kornik.

At a recent symposium held in Johannesburg, the World Health Organisation (WHO), launched its recommendations on how the shortage of health personnel in rural facilities can be improved. In its recommendations the WHO looked at three aspects relating to the needs of health professionals for rural health. These are remuneration, education and the personal circumstances of workers. The body says most health workers are concerned about their children are schooling requirements should they relocate to a rural area. Getting fresh graduates to work in rural hospitals as a compulsory measure was also discussed. The WHO says it will need to partner with key stakeholders and policy makers at country level to ensure their goals are reached.