Doctor retention and distribution in post-apartheid South Africa: tracking medical graduates (2007–2011) from one university

Abstract Background Doctor emigration from low- and middle-income countries represents a financial loss and threatens the equitable delivery of healthcare. In response to government imperatives to produce more health professionals to meet the country’s needs, South African medical schools increased their student intake and changed their selection criteria, but little is known about the impact of these changes. This paper reports on the retention and distribution of doctors who graduated from the University of the Witwatersrand, South Africa (SA), between 2007 and 2011. Methods Data on 988 graduates were accessed from university databases. A cross-sectional descriptive email survey was used to gather information about graduates’ demographics, work histories, and current work settings. Frequency and proportion counts and multiple logistic regressions of predictors of working in a rural area were conducted. Open-ended data were analysed using content analysis. Results The survey response rate was 51.8%. Foreign nationals were excluded from the analysis because of restrictions on them working in SA. Of 497 South African respondents, 60% had completed their vocational training in underserved areas. At the time of the study, 89% (444) worked as doctors in SA, 6.8% (34) practised medicine outside the country, and 3.8% (19) no longer practised medicine. Eighty percent of the 444 doctors still in SA worked in the public sector. Only 33 respondents (6.6%) worked in rural areas, of which 20 (60.6%) were Black. Almost half (47.7%) of the 497 doctors still in SA were in specialist training appointments. Conclusions Most of the graduates were still in the country, with an overwhelmingly urban and public sector bias to their distribution. Most doctors in the public sector were still in specialist training at the time of the study and may move to the private sector or leave the country. Black graduates, who were preferentially selected in this graduate cohort, constituted the majority of the doctors practising in rural areas. The study confirms the importance of selecting students with rural backgrounds to provide doctors for underserved areas. The study provides a baseline for future tracking studies to inform the training of doctors for underserved areas.

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Public Sector Employment, Quality of Government, and Well-Being: A Global Analysis

International Area Studies Review ◽

10.1177/22338659211011747 ◽

2021 ◽

pp. 223386592110117

Author(s):

Robert Davidson ◽

Alexander Pacek ◽

Benjamin Radcliff

Keyword(s):

Public Sector ◽

Global Analysis ◽

Well Being ◽

Subjective Well Being ◽

Cross Sectional ◽

Political Factors ◽

The Public ◽

Employment Quality ◽

The Impact

While a growing literature within the study of subjective well-being demonstrates the impact of socio-political factors on subjective well-being, scholars have conspicuously failed to consider the role of the size and scope of government as determinants of well-being. Where such studies exist, the focus is largely on the advanced industrial democracies of the Organization for Economic Co-Operation and Development. In this study, we examine the size of the public sector as a determinant of cross-national variation in life satisfaction across a worldwide sample. Our findings strongly suggest that as the public sector grows, subjective well-being increases as well, conditional on the extent of quality of government. Using cross-sectional data on 84 countries, we show this relationship has an independent and separable impact from other economic and political factors.

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SASS: South African Simulation Survey – a review of simulation-based education

Southern African Journal of Anaesthesia and Analgesia ◽

10.36303/sajaa.2019.25.4.2191 ◽

2019 ◽

pp. 12-20

Author(s):

R Swart ◽

R Duys ◽

ND Hauser

Keyword(s):

South Africa ◽

South African ◽

Undergraduate Students ◽

Online Survey ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Survey Tool ◽

South African Society ◽

Simulation Based ◽

The Impact

Background: Simulation-based education (SBE) has been shown to be an effective and reproducible learning tool. SBE is used widely internationally. The current state of SBE in South Africa is unknown. To the best of our knowledge this is the first survey that describes the use and attitudes towards SBE within South Africa. Methods: An online survey tool was distributed by email to: i) the South African Society of Anaesthesiologists (SASA) members; and ii) known simulation education providers in South Africa. The respondents were grouped into anaesthesia and non-anaesthesia participants. Descriptive statistics were used to analyse the data. Ethics approval was obtained: HREC REF 157/2017. Results: The majority of the respondents provide SBE and integrate it into formal teaching programmes. There is a will amongst respondents to grow SBE in South Africa, with it being recognised as a valuable educational tool. The user groups mainly targeted by SBE, were undergraduate students, medical interns, registrars and nurses. Learning objectives targeted include practical skills, medical knowledge, critical thinking and integrated management. Amongst anaesthesia respondents: the tool most commonly used to assess the quality of learner performance during SBE, for summative assessment, was ‘expert opinion’ (33%); the most frequent methods of evaluating SBE quality were participant feedback (42%) and peer evaluation (22%); the impact of SBE was most frequently assessed by informal discussion (42%) and learner feedback (39%). In anaesthesia SBE largely takes place within dedicated simulation facilities on site (47%). Most respondents report access to a range of SBE equipment. The main reported barriers to SBE were: finance, lack of trained educators, lack of equipment and lack of protected time. A limited number of respondents report engaging in SBE research. There is a willingness in both anaesthesia and non-anaesthesia groups (96% and 89% respectively) to collaborate with other centres. Conclusion: To the best of our knowledge this publication provides us with the first cross-sectional survey of SBE in anaesthesia and a selection of non-anaesthetic respondents within South Africa. The majority of respondents indicate that SBE is a valuable education tool. A number of barriers have been identified that limit the growth of SBE within South Africa. It is hoped that with a commitment to ongoing SBE research and evaluation, SBE can be grown in South Africa.

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Doctors’ Extended Shifts as Risk to Practitioner and Patient: South Africa as a Case Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165853 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5853

Author(s):

Koot Kotze ◽

Helene-Mari van der Westhuizen ◽

Eldi van Loggerenberg ◽

Farah Jawitz ◽

Rodney Ehrlich

Keyword(s):

South Africa ◽

South African ◽

Medical Practice ◽

Health And Safety ◽

Working Hours ◽

Middle Income ◽

The Impact ◽

Safe Working ◽

Working Hour

Extended shifts are common in medical practice. This is when doctors are required to work continuously for more than 16 h, with little or no rest, often without a maximum limit. These shifts have been a part of medical practice for more than a century. Research on the impact of fatigue presents compelling evidence that extended shifts increase the risk of harm to patients and practitioners. However, where the number of doctors is limited and their workloads are not easily reduced, there are numerous barriers to reform. Some of these include a perceived lack of safer alternatives, concerns about continuity of care, trainee education, and doctors’ preferences. As such, working hour reorganisation has been contentious globally. South Africa, a middle-income country where extended shifts are unregulated for most doctors, offers a useful case study of reform efforts. The South African Safe Working Hours campaign has promoted working hour reorganization through multi-level advocacy efforts, although extended shifts remain common. We propose that extended shifts should be regarded as an occupational hazard under health and safety legislation. We suggest options for managing the risks of extended shifts by adapting the hierarchy of controls for occupational hazards. Despite the challenges reform pose, the practice of unregulated extended shifts should not continue.

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Public sector entrepreneurship in South Africa

Journal of Entrepreneurship and Public Policy ◽

10.1108/jepp-08-2019-112 ◽

2019 ◽

Vol 8 (4) ◽

pp. 500-512

Author(s):

Boris Urban ◽

Mmapoulo Lindah Nkhumishe

Keyword(s):

South Africa ◽

Public Sector ◽

South African ◽

Middle Level ◽

Primary Data ◽

Content Type ◽

The Public ◽

Provision Of Services ◽

Efficiency And Effectiveness ◽

Organisational Factors

Purpose Many unanswered questions remain regarding the authors’ understanding of how entrepreneurship can be fostered in the public sector. To fill this knowledge gap, the purpose of this paper is to conduct an empirical investigation to determine the relationship between different organisational factors and entrepreneurial orientation (EO) in the South African public sector. Design/methodology/approach Primary data are sourced from middle-level managers at municipalities in the three largest provinces across South Africa. Hypotheses are statistically tested using regression analyses. Findings Results reveal that the organisational antecedents of structure and culture explain a significant amount of variation in the EO dimensions of innovativeness, risk taking and proactiveness. Additionally, the findings on organisational rewards converge with an emerging stream of research which highlights that while rewards works well to motivate individuals in the private sector, they are negatively correlated with entrepreneurship in the public sector. Research limitations/implications The study implications relate to the efficiency and effectiveness of service delivery of municipalities in South Africa. Due to increases in community protest actions, it is necessary not only to maximise efficiency in the provision of services, but also to innovate and be proactive in order to achieve more with less resources. Originality/value By investigating previously unrelated factors in the public sector, the authors create closer conceptual and empirical links between the role of organisational factors and each of the EO dimensions. Furthermore, the study takes place in a relatively under-researched entrepreneurship and public sector context.

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Intersectoral (in)activity: towards an understanding of public sector department links between water, sanitation and hygiene (WASH) and childhood undernutrition in South Africa

Health Policy and Planning ◽

10.1093/heapol/czaa028 ◽

2020 ◽

Vol 35 (7) ◽

pp. 829-841 ◽

Cited By ~ 1

Author(s):

D J Momberg ◽

P Mahlangu ◽

B C Ngandu ◽

J May ◽

S A Norris ◽

...

Keyword(s):

South Africa ◽

Public Sector ◽

Nutritional Status ◽

Physical Growth ◽

Human Right ◽

Poor Child ◽

Middle Income ◽

Sanitation And Hygiene ◽

Nutritional Status Of Children ◽

The Impact

Abstract Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), contribute to poor child health, nutritional status and physical growth. The primary responsibility for the provision of water and sanitation, as a basic service and human right, lies with the State, as such, a number of stakeholders are involved. Despite relatively high levels of WASH infrastructure coverage in South Africa, enteric infections and stunting remain high for a middle-income country. The aim of this study is to elucidate the landscape of WASH in South Africa in relation to nutritional status of children under the age of 5 years in the South African, Gauteng and City of Johannesburg contexts. The authors detailed the national and provincial public sector departments and through purposive sampling proceeded to map the various departments and associated policies that are responsible for the provision of WASH facilities, as well the nutritional status of children. Of the six policies identified for review, three mentioned WASH, nutrition and children; however, none explicitly linked WASH to nutritional status in children. An in-depth review and analysis of these three crucial policy documents was conducted. Finally, a set of expert interviews were conducted and a consensus development conference convened, with experts at the intersection between WASH and nutritional status. The authors found that the public sector would benefit from better integration of the concept of WASH into their policy, planning and implementation frameworks. The WASH sector should emphasize the role in which WASH plans consider the impact of WASH on the nutritional status of children. The various public sector departments involved in WASH service provision, and other WASH stakeholders, including community-based organizations, non-governmental organizations and intergovernmental organizations, should be involved in the decision-making of the nutrition sector.

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ASSESSING THE IMPACT: Mandatory and minimum sentences in South Africa

South African Crime Quarterly ◽

10.17159/2413-3108/2005/v0i14a1005 ◽

2016 ◽

Author(s):

Julia Sloth-Nielsen ◽

Louise Ehlers

Keyword(s):

South Africa ◽

South African ◽

Violent Crime ◽

The Public ◽

The Impact

The legislation passed in 1997 that provides for mandatory minimum sentences for serious crimes was recently extended for another two years. At the time, the aim was to reduce serious and violent crime, achieve consistency in sentencing, and satisfy the public that sentences were sufficiently severe. This article argues that the legislation has achieved little or no significant impact with regard to these goals. Instead, many agree that the provisions have exacerbated the problem of overcrowding in South African prisons.

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Cost Profiling of Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia Treatment in South Africa: Medicines That Are Still Too Expensive to Swallow

10.21203/rs.3.rs-751789/v1 ◽

2021 ◽

Author(s):

Reeya Singh ◽

Frasia Oosthuizen ◽

Ebenezer Wiafe ◽

Kofi Boamah Mensah ◽

Varsha Bangalee

Keyword(s):

South Africa ◽

Public Sector ◽

Chronic Myeloid Leukemia ◽

Private Sector ◽

Tyrosine Kinase ◽

Tyrosine Kinase Inhibitors ◽

South African ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

The Public

Abstract Background The development of tyrosine kinase inhibitors (TKIs) has improved chronic myeloid leukemia (CML) management and increased CML prevalence due to low mortality rates. CML management is potentially lifelong and expensive and requires pharmacoeconomic approaches and regular review of therapy to ensure that patients obtain cost-effective therapeutic outcomes. Although the introduction of TKIs generics has improved the availability of TKIs, the high-cost implications continue to hinder TKIs accessibility and translate into poor quality of life. To improve the availability and accessibility of TKIs in South Africa, interventional programs have been instrumental. A notable intervention is the collaborative effort of Novartis pharmaceuticals and The Max Foundation which has provided free access to Imatinib to patients in need. In recognition of the needs of CML patients, this study aimed to provide an overview of TKIs regulatory approval, availability, and cost profile in the South African (SA) context for the 2019 period. Methods The researchers searched the South African Health Products Regulatory Authority (SAHPRA) website on 20 August 2019 to identify TKIs, generic and innovator brands, that was duly registered. The costs of the registered TKIs were extracted from the Medicines Price Registry (2019) and the Department of Health awarded tenders for oncology medications (2019). The results were analysed quantitatively using Microsoft Excel and presented as tables. Results Three TKIs were registered in SA: Imatinib, Dasatinib, and Nilotinib. Generics were only available for Imatinib. Despite the numerous Imatinib generics available in the private sector, treatment for CML chronic phase (CP) patients in the private sector was more expensive than in the public sector. Apparent cost inequality was noted where the same TKI (Nilotinib 200 mg) costs substantially less (by 92.4%) in the public sector than in the private sector. Conclusion The study concluded that the accessibility to CML management in the private sector is hindered by the high cost of therapy compared to the public sector. The availability of generic forms of Imatinib eliminated monopoly and improved medicated access compared to Dasatinib and Nilotinib. To improve CML medication access, stakeholders' engagement is required to control cost.

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Does Farmland Size Affect the Collective Action in Rural Areas? An Empirical Study on the Public Irrigation System in China

E3S Web of Conferences ◽

10.1051/e3sconf/202129201028 ◽

2021 ◽

Vol 292 ◽

pp. 01028

Author(s):

Liangzhen Zang ◽

Yiqing Su

Keyword(s):

Public Sector ◽

Collective Action ◽

Rural Areas ◽

Positive Impact ◽

Irrigation System ◽

The Public ◽

Land Circulation ◽

Per Capita ◽

Agricultural Business ◽

The Impact

Since smallholders accounted for a high proportion of 98.1% among the 207 million agricultural business households across China, it is particularly important to study the impact of farmland size on the provision of public goods attached to the public sector industries from the perspective of the irrigation collective action in rural areas. Based on the survey data of 283 villages in China, this paper finds that the farmland size has a positive impact on irrigation collective action, although the average of per capita farmland area is only 0.214 hectares in each household of China. Therefore, it is necessary to promote the farmland scale operation by land circulation, so as to improve the ability of collective action and the development of public sector industries in rural areas of China.

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Trends in the nephrologist workforce in South Africa (2002–2017) and forecasting for 2030

PLoS ONE ◽

10.1371/journal.pone.0255903 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255903

Author(s):

Dominic Dzamesi Kumashie ◽

Ritika Tiwari ◽

Muhammed Hassen ◽

Usuf M. E. Chikte ◽

Mogamat Razeen Davids

Keyword(s):

South Africa ◽

Public Sector ◽

Middle Income ◽

North West ◽

The Public ◽

The North ◽

Training Capacity ◽

Northern Cape ◽

Public And Private Sector ◽

Kidney Health

Background The growing global health burden of kidney disease is substantial and the nephrology workforce is critical to managing it. There are concerns that the nephrology workforce appears to be shrinking in many countries. This study analyses trends in South Africa for the period 2002–2017, describes current training capacity and uses this as a basis for forecasting the nephrology workforce for 2030. Methods Data on registered nephrologists for the period 2002 to 2017 was obtained from the Health Professions Council of South Africa and the Colleges of Medicine of South Africa. Training capacity was assessed using data on government-funded posts for nephrologists and nephrology trainees, as well as training post numbers (the latter reflecting potential training capacity). Based on the trends, the gap in the supply of nephrologists was forecast for 2030 based on three targets: reducing the inequalities in provincial nephrologist densities, reducing the gap between public and private sector nephrologist densities, and international benchmarking using the Global Kidney Health Atlas and British Renal Society recommendations. Results The number of nephrologists increased from 53 to 141 (paediatric nephrologists increased from 9 to 22) over the period 2002–2017. The density in 2017 was 2.5 nephrologists per million population (pmp). In 2002, the median age of nephrologists was 46 years (interquartile range (IQR) 39–56 years) and in 2017 the median age was 48 years (IQR 41–56 years). The number of female nephrologists increased from 4 to 43 and the number of Black nephrologists increased from 3 to 24. There have been no nephrologists practising in the North West and Mpumalanga provinces and only one each in Limpopo and the Northern Cape. The current rate of production of nephrologists is eight per year. At this rate, and considering estimates of nephrologists exiting the workforce, there will be 2.6 nephrologists pmp in 2030. There are 17 government-funded nephrology trainee posts while the potential number based on the prescribed trainer-trainee ratio is 72. To increase the nephrologist density of all provinces to at least the level of KwaZulu-Natal (2.8 pmp), which has a density closest to the country average, a projected 72 additional nephrologists (six per year) would be needed by 2030. Benchmarking against the 25th centile (5.1 pmp) of upper-middle-income countries (UMICs) reported in the Global Kidney Health Atlas would require the training of an additional eight nephrologists per year. Conclusions South Africa has insufficient nephrologists, especially in the public sector and in certain provinces. A substantial increase in the production of new nephrologists is required. This requires an increase in funded training posts and posts for qualified nephrologists in the public sector. This study has estimated the numbers and distribution of nephrologists needed to address provincial inequalities and achieve realistic nephrologist density targets.

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Centrist television in the democratic South Africa: policymakers fail to answer the regional/local question, 1990-2011

Info ◽

10.1108/info-05-2013-0029 ◽

2013 ◽

Vol 15 (5) ◽

pp. 128-140

Author(s):

Chris Armstrong

Keyword(s):

South Africa ◽

Policy Implementation ◽

Conceptual Framework ◽

South African ◽

Public Interest ◽

Content Type ◽

The Public ◽

Media Regulation ◽

The Impact

Purpose – The purpose of this paper is to explore the disconnect between policy intent and policy implementation in relation to regional/local (sub-national) TV deliverables in South Africa between 1990 and 2011, and evaluate the impact of this disconnect in pursuit of public interest objectives. Design/methodology/approach – The article is based on a research case study in which data extracted from policy documents and interviews were qualitatively analysed via the Kingdon “policy streams” framework and the Feintuck and Varney public interest media regulation framework. Findings – It was found that ruptures in deliberative policymaking, and policy implementation missteps, undermined sub-national TV delivery and, in turn, undermined pursuit of the public interest. Originality/value – By combining a political science conceptual framework with a media policy conceptual framework, the article provides unique insights into South African TV policymaking in the early democratic era.

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