An assessment of the Remunerative Work Outside Public Sector Policy at the Johannesburg Hospital
Date
2008-10-13T13:40:51Z
Authors
Khan, Farzana
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Abstract
Good infrastructure and equitable distribution of resources are critical factors in
securing equal health care access to all. Poverty, food production and distribution,
water, sanitation, housing, environmental protection and education all impact on
health (Lee and Mills, 1983). Despite the multi-dimensional determinants of health
and healthcare, one of the most noticeable challenges facing the health care
system is that of human resources. Health care systems cannot function optimally
without sufficient levels and adequate distribution of health care personnel. Brain
drain in South Africa is one of the critical areas of concern according to the Health
Minister (Poggenpoel, 2004). Recruitment and retention of health care workers
within public health institutions is still one of the most critical challenges facing
South Africa. Poor working conditions; limited consumable resources and
mismanagement of facilities aggravate the problem of shortage of skilled health
care personnel.
Limited private practice (LPP) is seen as one of the many mechanisms to retain
health care personnel. Limited Private Practice or moonlighting allows for
government or state employees to perform private duties within certain time
parameters. LPP is common in many developing countries, including South Africa.
This study focuses on the health professionals engaging in limited private practice
in South Africa. Remunerative Work Outside Public Sector (RWOPS) is potentially
an alternative term used for LPP in South Africa. The study focuses on the evolutionary process of the RWOPS policy and explores
the attitudes and perceptions of the health professionals and management at the
Johannesburg Hospital with regards to the RWOPS policy. Policy documents,
press releases, international studies and official documents collected through
searches on the world-wide-web have provided the bases for the evolutionary
process of the study. The perception and attitudes were determined through a selfadministered
structured questionnaire. Participants were randomly selected from a
list obtained from the Johannesburg Hospital Human Resource personnel. Some
participants were selected using snowball sampling. A total of forty two
questionnaires were handed out to the respective participants with feedback from
thirty five participants. The questionnaire compromised of closed and open ended
questions. 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 responsible
for processing the RWOPS applications)
· Allied Health Professionals (all levels of physiotherapists, occupational
therapists, pharmacists and the speech and hearing therapists) The results are presented graphically. The data was thematically analyzed
allowing the researcher to identify the role of the key actors in the implementation
process. The Walt and Gilson (1994) model was used to analyze and assess the
RWOPS policy.
A pilot study was conducted to determine if the validity and reliability of the
questionnaire in determining the role, attitudes and perceptions of these key actors
with regards to the RWOPS policy. The pilot study was included in the actual
sample population. Management n=2; doctors n=11; nurses n=15 and allied health
n=7 were the total number of respondents.
Most individuals felt that a shortage of human resource was the most critical
challenge. Most participants are not familiar with the RWOPS policy even though
seventy seven percent of the participants answered yes to being familiar with the
policy. The expectation from many participants was for them to receive substantial
financial incentives through the policy. This relates the lack of knowledge on the
policy terms. Participants also felt that certain professions and individuals
benefited the most from the RWOPS resulting in animosity amongst health care
workers at the Johannesburg Hospital. The questionnaires indicated that there
was minimal input from all the relevant key actors. This lack of consultation with all
relevant actors or perhaps a miscommunication amongst the relevant players may
have contributed to the abuse of this policy.
Description
Keywords
RWOPS, Remunerative Work Outside Public Sector Policy, Johannesburg Hospital