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

Khan, Farzana
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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.
RWOPS, Remunerative Work Outside Public Sector Policy, Johannesburg Hospital