Reid S J, Peacocke J, Kornik S, Wolvaardt G
Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2018 Aug 30;108(9):741-747. doi: 10.7196/SAMJ.2018.v108i9.13070.
Compulsory community service (CS) for health professionals for 12 months was introduced in South Africa (SA) in 1998, starting with medical practitioners. Up to 2014, a total of 17 413 newly qualified doctors and ~44 000 health professionals had completed their year of service in public health facilities around the country. While a number of studies have described the experience and effects of CS qualitatively, none has looked at the programme longitudinally.
To describe the findings and analyse trends from surveys of CS doctors between 2000 and 2014, specifically with regard to their distribution, support, feedback and career plans.
A consecutive cross-sectional descriptive study design was used based on annual national surveys of CS doctors. The study population of between 1 000 and 1 300 each year was surveyed with regard to their origins, allocations, experiences of the year and future career plans.
The total study population varied between 1 057 and 1 308 each year, with response rates of 20 - 77%. The average turn-up rate of 89% showed a decreasing tendency, while 77% of respondents were satisfied with the allocation process. Over the 15-year period, the proportion of CS doctors who were black and received a study bursary, and who were allocated to rural areas and district hospitals, increased. The great majority believed that they had made a difference (91%) and developed professionally (81%) over the course of the year, but only about half felt adequately supported clinically and administratively. The attitude towards CS of the majority of respondents shifted significantly from neutral to positive over the course of the 15 years. In terms of future career plans, 50% hoped to specialise, a decreasing minority to go overseas or into private practice, and a constant 15% to work in rural or underserved areas.
This study is the first to track the experience of compulsory CS over time in any country in order to describe the trends once it had become institutionalised. The SA experience of CS for doctors over the first 15 years appears to have been a successively positive one, and it has largely met its original objectives of redistribution of health professionals and professional development. Greater attention needs to be given to orientation, management support and clinical supervision, and focusing professional development opportunities on the important minority who are prepared to stay on longer than their obligatory year. CS still needs to be complemented by other interventions to capitalise on its potential.
1998年南非开始对卫生专业人员实施为期12个月的义务社区服务（CS），首先从执业医师开始。截至2014年，共有17413名新获得资格的医生和大约44000名卫生专业人员在全国各地的公共卫生机构完成了他们的服务年。虽然有一些研究定性地描述了义务社区服务的经历和影响，但没有一项研究对该项目进行纵向研究。
描述2000年至2014年间义务社区服务医生调查的结果并分析趋势，特别是关于他们的分布、支持、反馈和职业规划。
基于对义务社区服务医生的年度全国性调查，采用连续横断面描述性研究设计。每年对1000至1300名研究对象进行调查，了解他们的出身、分配情况、服务年经历和未来职业规划。
每年的研究对象总数在1057至1308之间，回复率为20%至77%。89%的平均出勤率呈下降趋势，而77%的受访者对分配过程感到满意。在15年期间，黑人、获得学习助学金、被分配到农村地区和地区医院的义务社区服务医生比例有所增加。绝大多数人认为他们在这一年中产生了影响（91%）并在专业上得到了发展（81%），但只有大约一半的人觉得在临床和行政方面得到了充分支持。在这15年中，大多数受访者对义务社区服务的态度从中立显著转变为积极。在未来职业规划方面，50%的人希望专科化，希望出国或从事私人执业的人越来越少，而有15%的人始终希望在农村或服务不足地区工作。
本研究是首个在任何国家随时间追踪义务社区服务经历的研究，目的是在其制度化后描述其趋势。南非医生义务社区服务的前15年经历似乎一直是积极的，并且在很大程度上实现了其最初的卫生专业人员重新分配和专业发展目标。需要更加关注入职培训、管理支持和临床监督，并将专业发展机会集中在准备在义务服务年之后继续留任更长时间的重要少数群体身上。义务社区服务仍需辅以其他干预措施以充分发挥其潜力。
