Analyzing the implementation of the rural allowance in hospitals in North West Province, South Africa

Abstract

Using a policy analysis framework, we analyzed the implementation and perceived effectiveness of a rural allowance policy and its influence on the motivation and retention of health professionals in rural hospitals in the North West province of South Africa. We conducted 40 in-depth interviews with policy-makers, hospital managers, nurses, and doctors at five rural hospitals and found weaknesses in policy design and implementation. These weaknesses included: lack of evidence to guide policy formulation; restricting eligibility for the allowance to doctors and professional nurses; lack of clarity on the definition of rural areas; weak communication; and the absence of a monitoring and evaluation framework. Although the rural allowance was partially effective in the recruitment of health professionals, it has had unintended negative consequences of perceived divisiveness and staff dissatisfaction. Government should take more account of contextual and process factors in policy formulation and implementation so that policies have the intended impact.

Security and skills: the two key issues in health worker migration

“…Within the public sector, a variety of financial and non-financial initiatives (such as the Hospital Revitalisation Programme, Rural and Scarce Skills Allowance, and Occupation Specific Dispensation) have been implemented in order to improve issues of motivation and retention. These incentives have had varying degrees of success at improving retention of health workers within their posts (27, 28). In addition, initiatives such as the ‘Home Coming Revolution’ and the African Health Initiative are working to stimulate the return of South African expatriates.…”

Slaves of the state - medical internship and community service in South Africa

“…21 This argument is fallacious because financial incentives alone are insufficient to motivate and retain all levels of health practitioners in rural areas, 22 and it is physically impossible for males or females to function optimally without sleep, no matter how much they are paid to do so.…”

Adaptation of the global frameworks for community based rehabilitation in southern Africa: a proof of concept

“…Evidence is necessary to augment the understanding of CBR. Lack of empirical evidence for policy development or evaluation of existing policy is recognized as one of the factors for a weak policy environment 18,19,24 , as well as failure to translate research findings into policy -the evidencepolicy gap 25 -and these could be factors contributing to the findings presented in this paper. A systematic review is currently underway to ascertain the veracity of this criticism regarding CBR literature in southern Africa.…”

“…Grimshaw et al 25 recommend systematic reviews as a method of synthesizing evidence and therefore the basic unit of knowledge translation. A study of the 'perceived effectiveness and consequences' of policy is recommended by Ditlopo et al 24 …”

“…The WHO, through its regional Disability and Rehabilitation technical leads, could play a facilitator role to ensure that the intent of the global frameworks is understood prior to local adaptation. Governments should also put in place mechanisms to review policies periodically 24 and evaluate their ability to meet new needs.…”