An assessment of the Remunerative Work Outside Public Sector Policy at the Johannesburg Hospital

[摘要] Good infrastructure and equitable distribution of resources are critical factors insecuring equal health care access to all. Poverty, food production and distribution,water, sanitation, housing, environmental protection and education all impact onhealth (Lee and Mills, 1983). Despite the multi-dimensional determinants of healthand healthcare, one of the most noticeable challenges facing the health caresystem is that of human resources. Health care systems cannot function optimallywithout sufficient levels and adequate distribution of health care personnel. Braindrain in South Africa is one of the critical areas of concern according to the HealthMinister (Poggenpoel, 2004). Recruitment and retention of health care workerswithin public health institutions is still one of the most critical challenges facingSouth Africa. Poor working conditions; limited consumable resources andmismanagement of facilities aggravate the problem of shortage of skilled healthcare personnel.Limited private practice (LPP) is seen as one of the many mechanisms to retainhealth care personnel. Limited Private Practice or moonlighting allows forgovernment or state employees to perform private duties within certain timeparameters. LPP is common in many developing countries, including South Africa.This study focuses on the health professionals engaging in limited private practicein South Africa. Remunerative Work Outside Public Sector (RWOPS) is potentiallyan alternative term used for LPP in South Africa. The study focuses on the evolutionary process of the RWOPS policy and exploresthe attitudes and perceptions of the health professionals and management at theJohannesburg Hospital with regards to the RWOPS policy. Policy documents,press releases, international studies and official documents collected throughsearches on the world-wide-web have provided the bases for the evolutionaryprocess of the study. The perception and attitudes were determined through a selfadministeredstructured questionnaire. Participants were randomly selected from alist obtained from the Johannesburg Hospital Human Resource personnel. Someparticipants were selected using snowball sampling. A total of forty twoquestionnaires were handed out to the respective participants with feedback fromthirty five participants. The questionnaire compromised of closed and open endedquestions. The sample population consisted of the following participants:· Nursing personnel (these included nurses at all levels, professional nurses,senior nurses, chief nurses as well as representatives from DENOSA)· Doctors (all levels registrars, senior registrars, Head Of Department’s, consultants and reps from SAMA)· Management (the CEO and some human resource personnel responsiblefor processing the RWOPS applications)· Allied Health Professionals (all levels of physiotherapists, occupationaltherapists, pharmacists and the speech and hearing therapists) The results are presented graphically. The data was thematically analyzedallowing the researcher to identify the role of the key actors in the implementationprocess. The Walt and Gilson (1994) model was used to analyze and assess theRWOPS policy.A pilot study was conducted to determine if the validity and reliability of thequestionnaire in determining the role, attitudes and perceptions of these key actorswith regards to the RWOPS policy. The pilot study was included in the actualsample population. Management n=2; doctors n=11; nurses n=15 and allied healthn=7 were the total number of respondents.Most individuals felt that a shortage of human resource was the most criticalchallenge. Most participants are not familiar with the RWOPS policy even thoughseventy seven percent of the participants answered yes to being familiar with thepolicy. The expectation from many participants was for them to receive substantialfinancial incentives through the policy. This relates the lack of knowledge on thepolicy terms. Participants also felt that certain professions and individualsbenefited the most from the RWOPS resulting in animosity amongst health careworkers at the Johannesburg Hospital. The questionnaires indicated that therewas minimal input from all the relevant key actors. This lack of consultation with allrelevant actors or perhaps a miscommunication amongst the relevant players mayhave contributed to the abuse of this policy.

[发布机构] University of the Witwatersrand