Perceptions of and attitudes to the compulsory community service programme for therapists in KwaZulu-Natal, 2005.
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Date
2009
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Abstract
Compulsory community service programmes have been initiated in many countries to recruit
health care professionals to provide services in rural and under-served areas. However, the
success or failure of the Community Service Programme depends largely on the attitudes of
the professionals, their understanding of the programme's objectives, their preparedness for
working in these areas and their ability to adapt to a new and challenging experience.
Aim
The aim ofthis study was to assess therapist's perceptions and attitudes about the compulsory
Community Service Programme in KwaZulu-Natal in 2005 and to assess whether these
changed during the year.
Methods
An observational cross sectional study with a descriptive and analytic component was
conducted on commencement and after completion of community service. The therapists
completed a self-administered questionnaire before and after their community service.
Results
A total of 126 (89% of 142) therapists responded to the initial questionnaire, 59 (42%)
completed the exit questionnaire of which 47 (33%) completed both the questionnaire at
commencement and completion of community service. Despite the poor response rate,
similarities in perceptions and attitudes were noted with other studies conducted nationally
and internationally. At onset 50% indicated that they would work in the public sector in the
future and this proportion declined to 35% by exit. Even fewer (24%) said they would work
in a rural area in the future. Only 16% reported that they would stay on at the same institution
the year after community service. There was also no significant association between
therapists collecting a rural allowance and expressing an interest to work in a rural area in the
future (p=0.78) or staying at the same institution in the years after community service
(p=0.32). However, therapists working in urban areas were more likely to say they would
work in a rural area in the future (p=0.018). The comparisons between the occupational
catergories showed that for support and supervision, the Speech Therapy and Audiology
Forum was considered significantly (p=O.OOI) supportive compared to the Physiotherapy
Forum.
There was no significant difference within the occupational catergories in their perceptions of
support, mentoring and supervision, attitude, psychological coping, personal and professional
gains, safety issues and the amount of community outreach conducted. All groups were
similarly resource constrained. Language was a barrier for 50% of all community service
therapists and impeded their professional functioning.
Discussion
Despite the challenges experienced by community service therapists the majority felt that
they had made a difference in the community in which they have been placed. The obligation
to work in rural and under-served areas was personally and professionally rewarding.
Particular concerns centred on support, supervision, training, resources and language barriers
in providing better service delivery.
Recommendations
To achieve its objectives in relation to compulsory community service, which is to ensure an
improved provision of health services to all citizens ofthe country, the Department ofHealth
should consider multiple strategies including financial incentives such as rural allowances
and non-financial incentives to retain health care personnel in rural and under-served areas. A
long-term strategy that addresses human resources in a comprehensive manner needs to be
developed to improve staffing and quality health services in these areas.
Description
Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2009.
Keywords
Allied health personnel--Job satisfaction--KwaZulu-Natal., Theses--Public health medicine.