RESUMO
BACKGROUND: Despite supernumerary registrars (SNRs) being hosted in South African (SA) training programmes, there are no reports of their experience. OBJECTIVES: To evaluate the experience of SNRs at the University of Cape Town, SA, and the experience of SNRs from the perspective of SA registrars (SARs). METHODS: SNRs and SARs completed an online survey in 2012. RESULTS: Seventy-three registrars responded; 42 were SARs and 31 were SNRs. Of the SNRs 47.8% were self-funded, 17.4% were funded through private organisations, and 34.8% were funded by governments. Average annual income was ZAR102 349 (range ZAR680 - 460 000). Funding was considered insufficient by 61.0%. Eighty-seven percent intended to return to their home countries. Personal sacrifices were deemed worthwhile from academic (81.8%) and social (54.5%) perspectives, but not financially (33.3%). Only a small majority were satisfied with the orientation provided and with assimilation into their departments. Almost half experienced challenges relating to cultural and social integration. Almost all SARs supported having SNRs. SNRs reported xenophobia from patients (23.8%) and colleagues (47.8%), and felt disadvantaged in terms of learning opportunities, academic support and on-call allocations. CONCLUSIONS: SNRs are fee-paying students and should enjoy academic and teaching support equal to that received by SARs. Both the university and the teaching hospitals must take steps to improve the integration of SNRs and ensure that they receive equal access to academic support and clinical teaching, and also need to take an interest in their financial wellbeing. Of particular concern are perceptions of xenophobia from SA medical colleagues.
RESUMO
Background: The basis of the health system in South Africa is purported to be primary health care (PHC); as defined by the Alma Ata Declaration of 1978. This approach emphasises community involvement in all health-related activities; but it would appear that a very limited or selective PHC approach is actually being pursued in South Africa; without meaningful community participation or ownership. This study explores the involvement of exemplary medical and nursing clinical practitioners in non-clinical community-wide activities in terms of the primary health care approach; which demands a broader scope of practice than primary medical care. Methods: The objectives of the study were to identify exemplary medical and nurse practitioners in primary health care; to document their practices and perceptions with regard to their community involvement; to analyse the common themes arising from the findings; and to present recommendations based on the findings. Seventeen primary care clinicians in KwaZulu-Natal; half of whom were professional nurses and the rest medical practitioners; were purposively selected through their district managers. A team of four medical students was trained to collect the data and interviewed the subjects in their places of work using open-ended questions. The interviews were recorded; translated where necessary; and transcribed. Content analysis was carried out as a team; with the identification of major and minor themes.Results: The findings of this study were consistent with studies from other countries; with some interesting differences. The major themes that emerged from the data included the wide range of activities that subjects were involved in; the importance of relationships; the context of poverty; the frustrations of this kind of work; and the respondents' motivations. These are illustrated by numerous verbatim quotes from the respondents. Minor themes were the roles that the respondents play in the community; the difficulty of obtaining funding; and experiences in starting up. Significantly; the fact that the role of clinicians in the community emerged as only a minor theme rather than a major theme in this study indicates the absence of expectation and policy in this area of practice in South Africa. In the light of the supposed centrality of the primary healthcare approach in the national health system; this is a serious gap.Conclusion: The lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care is discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement; and this study serves as a basis for further research into the subject
