MarijeVersteeg

Project Manager

Rural Health Advocacy Project

28th September 2011

Dear Marije,

South African Guidelines on Rural Recruitment and Retention: a response from Rehabilitation

Thank you for sharing this document with us. As you are aware, we as rural therapists are in the process of organising ourselves as a sister organisation to RuDASA. As authors of this document, we have a mandate from the other potential members of this organisation to represent the views of rural therapists with regards to the issues raised here. The following summarises both email and in-person discussions with this group.

The rural therapists (physiotherapists, occupational therapists, speech and language therapists and psychologists) present in these discussions applauded and strongly supported the document. We would like to add the following points, of relevance particularly to the allied health professions (AHP’s):

EDUCATION

Rural therapists strongly supported the measures named, including the selection of rural students, and the promotion of rural electives and placements for health science students. Further, we feel:

  • In order to prepare rural learners for selection as health science students, partnerships with NGO’s and communities will be critical in order to address gaps in educational preparedness of rural school-goers.
  • The profile of AHP’s needs to be raised among communities, as many learners are not aware of these professions. Measures which address working conditions, remuneration, and management support for rehabilitation will contribute to this.
  • University curricula need to become more rurally-oriented. This may be achieved through partnerships with rural therapists (e.g. guest lecturing or joint clinical-academic posts).
  • Rural research agendas need to be pursued by universities through the above partnerships.
  • Rural therapists from the Eastern Cape have successfully recruited CSO’s to their hospitals through annual in-person presentations to 3rd and 4th-year students. Such visits should be arranged nation-wide, and receive provincial funding.
  • Masters and other post-graduate training should be developed that is both accessible (e.g. online or block-release) and relevant to rural therapists (e.g. Community-Based Rehabilitation). Current postgraduate study favours specialisation, rather than the generalist and community skills demanded by rural work.

REGULATORY

We support the recommendations made under this section, and wish to add the following comments:

  • Scope of practice: Posts need to be available and funded outside of hospitals in order for effective, accessible PHC rehabilitation to be made available, i.e. in all 3 proposed streams named in the re-engineering of PHC plan.
  • Such posts need to be supported by appropriate accommodation, TRANSPORT, budgets and facilities.
  • Mid-level workers: MLW’s have been a thorny and complex issue among rehabilitation professionals for some time. Their value in expanding access to rehabilitation is acknowledged, but the questions of their role, scope, training, registration and supervision need to be resolved in discussion with the professional boards and organisations as a matter of urgency.
  • Training for MLW’s, in order to be accessible and avoid disruption of current services, needs to allow continued working while studying. Often, the most suitable candidates are already employed, and have family responsibilities which preclude the proposed 2 years away at university.
  • MLW’s need to be part of a comprehensive rehabilitation plan, developed in line with the National Rehabilitation Policy (NRP), and fully committed to by the DoH and the provincial administrations.
  • Outreach by therapists, as recommended by the new PHC plans, is too often obstructed by management misunderstandings and lack of transport. Outreach needs to be strongly supported, both in policy and in budget and resource allocation.
  • Advertising processes need to be broadened, in terms of avenues allowed for making posts known, and streamlined in order to attract and recruit appropriate candidates.

FINANCIAL

Once again, we endorse the comments of the original document. We have the following to add:

  • Rehabilitation services need to be adequately supported in terms of facilities, resources, budget and transport. Therapists should no longer be expected to “make do” with nothing, or invest their private resources!
  • Financial processes (e.g. salaries, procurement) need to be streamlined and made more efficient. Current systems are woefully inadequate, leading to frustrations which greatly shorten the rural lifespan of many therapists.
  • Compensation for rural employment (the ISRDS node allowance) should be equivalent for doctors and AHP’s (for example, at present, AHP’s in deep rural areas receive the same “rural allowance” as staff in cities such as Mthatha, while their medical colleagues receive a larger “deep rural allowance”).

PERSONAL AND PROFESSIONAL SUPPORT

Often the only member of their profession present at a facility, and more often than not a new graduate, the rural therapist has a huge need for professional support and development beyond what is immediately available from the team. We support the calls made in the original document for better support to retain staff, but wish to highlight the following:

  • To ensure service quality, not to mention job satisfaction, it is essential that management recognises the needs of young therapists for continuing professional development.
  • Adequate budget needs to be made available for appropriate training, but innovative solutions such as hospital exchanges and “shadowing” of more experienced therapists need to be explored as alternatives.
  • A training “package”, covering the most essential therapeutic skills (e.g. basic seating, basic management of children with cerebral palsy) may be offered to CSO therapists, should they choose to stay on an additional year at their facility
  • Training should be sourced and funded in areas not currently covered by available courses, e.g. evaluating rural practice, CBR.
  • The network of rural therapists, currently under development,undertakes to identify, source and organise such training, and should have access to government funding to make this possible.
  • The improvement of basic management and systems within the hospital/district (including supplies, equipment maintenance, referrals, IT support etc) would improve not only quality of care, but also staff retention, as it is frequently frustration with such issues that lead therapists to seek work elsewhere.
  • Language needs of therapists need to be acknowledged by the allocation of appropriate translators where needed. Given the small numbers of AHP’s trained annually, and the difficulties faced with recruiting and graduating therapists from across the cultural spectrum, this will continue to be a major barrier to service effectiveness for the foreseeable future.
  • Therapists remaining in rural areas for several years should be rewarded with increased leave days, and the option of a sabbatical after a suitable period. In our experience, this would be a powerful way of retaining valuable experienced staff.

Thank you once again, for including us in this discussion, and we hope our input will be helpful.

Yours sincerely

Kate Sherry

Rural rehabilitation representative