The return-of-service or bursary schemes used by provincial health authorities in SA to help disadvantaged students obtain educational qualifications in the health sector could be improved by basing them on current and forecast health needs, says a group of researchers.
They added that there should be sufficient allocation of resources for future salary needs and efficient monitoring mechanisms to ensure compliance and the integrity of beneficiaries in underserved areas, reports University World News.
Bursaries, as return-of-service schemes are known, fund the study of beneficiaries on the understanding that they will serve health facilities, which battle to recruit health professionals, for at least the same number of years as the candidate was funded while studying.
The study, published in PLOS Global Public Health, titled ‘Are return-of-service bursaries an effective investment to build health workforce capacity? A qualitative study of key South African policymakers’, said: “While most beneficiaries are funded for the duration of their studies (an average of six years for studying medicine in South Africa, nine years in Cuba and four years for most other qualifications), some beneficiaries can be funded for less than that – for example, one year, if only offered the sponsorship in their final year of study.”
Bursaries ‘poorly managed’
However, the researchers, added, the bursaries “are often poorly planned, co-ordinated and monitored and have not been formally evaluated”.
They said some NGO return-of-service schemes, like the Umthombo Youth Development Foundation and the Friends of the Mosvold Hospital Scholarship Scheme, have found the schemes to have a good return on investment.
But there is little literature scrutinising the challenges, implementation processes and sustainability of the government-sponsored schemes.
The study’s work was, therefore, intended to fill this gap through an examination of insights from key policymakers in provincial health departments on how they have designed and implemented these training policies, and to identify barriers and solutions to implementation.
In addition, the researchers wanted to understand the insights of key policymakers in the country’s provinces to identify barriers and solutions to implementation of the schemes used to recruit and retain skilled health professionals.
The study drew the insights of 16 key SA policymakers from eight of the nine provinces through semi-structured, qualitative interviews.
Training needs
It found that the public health sector has 0.64 anaesthetists per 100,000 population, compared with 9.69 in the private health sector, whereas the country needs only five per 100,000 population.
In addition, the public health sector has only 33 per 100,000 medical practitioners compared with a global average of 176 per 100,000 population.
The researchers said the public sector’s primary care facilities are serviced by only 29.1% of the required professional nurses and midwives, and to resolve this shortfall “requires substantial and strategic investments in the workforce, as well as improvements in … planning, education, deployment, retention, management and remuneration”.
Researchers used the qualitative critical theory methodology, and designed the study to enable an assessment of the current situation that is attempting to overcome shortages of health professionals in underserved communities.
They said that, at times, the policy had been implemented with opportunity costs of not employing other deserving citizens and at times employing incompetent beneficiaries, thus rendering them non-sustainable.
“To have a lasting impact, health workforce planning strategies must be non-sporadic, long-term and continuous, with ongoing monitoring and evaluation to ensure they are contributing to these objectives and guard against unintended consequences,” they said.
Study details
Are return-of-service bursaries an effective investment to build health workforce capacity? A qualitative study of key South African policymakers
Sikhumbuzo A. Mabunda, Andrea Durbach, Wezile W. Chitha, Blake Angell, Rohina Joshi.
Published in PLOS Global Public Health on 5 May 2022
Abstract
Return-of-service schemes (RoS) or bursaries are used in South Africa and other nations to publicly fund the training of skilled health professionals in return for the beneficiary agreeing to return to serve in their local provinces on a year-for-year basis. This study aimed to understand insights of key policymakers in South African provinces to identify barriers and solutions to implementation of RoS schemes used to recruit and retain skilled health professionals. This research draws on the insights of 16 key South African policymakers from eight of its nine provinces through semi-structured, qualitative interviews. The respondents were interviewed through Microsoft Teams virtual platform, either in pairs (ten) or as individuals (six). Data were analysed using inductive, thematic analysis in NVIVO. The study was reported according to the consolidated criteria for reporting qualitative research. Respondents reported that the schemes had resulted in an increase in the number of skilled health professionals and had provided opportunities for study and employment for previously marginalised groups.
Formal evaluations of the impact of the schemes were not reported, however, a number of shortcomings with current schemes were identified that were likely limiting their effectiveness. Respondents reported a lack of foresight in the scheme implementation including a bias in the selection of beneficiaries towards medical professionals at the expense of other health workers. Furthermore, failure to plan for practice location when beneficiaries finished training limited the capacity of the schemes to meet the needs of local populations. Monitoring of recipients was limited by loopholes in contract design, decision-making and poor coordination between departments.
Between 1 and 30% of beneficiaries were reported to default their contracts with some not completing their studies, some not returning after completing their internship and others terminating their services before concluding their contracts. Return-of-service schemes have helped in overcoming health professional shortages. However, they haven’t been formally evaluated. Several planning and implementation shortcomings were identified which can be improved to enhance access to healthcare in South Africa.
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