20091222
allafrica

Cape Town — Too few community service doctors have been assigned to rural hospitals next year, casting doubt on President Jacob Zuma 's promise that HIV/AIDS patients will be able to get care at any state health facility by April, according to the Rural Health Advocacy Project.

The project is a partnership between the Rural Doctors Association of SA (Rudasa), the Wits Centre for Rural Health and the AIDS Law Project .

Only accredited health facilities can provide HIV/AIDS treatment. Most of these sites are in urban areas, forcing many patients living in rural areas to travel long distances to obtain the care they need.

During his speech on World AIDS Day on December 1, Zuma said "any citizen should be able to move into any health centre and ask for counselling, testing and even treatment if needed" and said the government would "work hard to ensure the systems are in place by the 31st of March".

Although suitably qualified nurses can provide AIDS drugs to patients, they need backup from doctors for complex cases.

"The whole idea behind community service was to provide some 'people power' for under- serviced areas, but that's not happening," said Rudasa's former president Prof Steve Reid.

The policy was introduced in 1998, and requires doctors to complete a compulsory year of community service after they qualify. Unlike other health professionals, doctors can say whether they want to work in urban or rural areas, and most opt for the better resourced hospitals in towns and cities. Since there are not enough community service doctors to fill all the vacant posts, rural areas come up short.

For example, seven of KwaZulu-Natal's rural hospitals -- Nkandla, Ceza, Ekombe, Estcourt, Mbongolwane, Nkonjeni and Reitvlei -- will not get community service doctors, according to analysis by Rudasa and the AIDS Law Project . Many other rural hospitals in the province were only allocated one or two community service doctors.

"Many of these hospitals have had vacant posts frozen, and are unable to fill posts for 2010 because of financial constraints. They will therefore remain chronically understaffed with little relief from community service, and the rural-urban inequity will be perpetuated by the 2010 placements," they said.

Overall, 66 (32%) of the 205 community service candidates were allocated to 35 rural hospitals in KwaZulu-Natal. A similar picture emerged in the Eastern Cape, where more than 30 hospitals had not been assigned a community service doctor, and three quarters of the placements were in urban areas.

The Department of Health had been working on a rural health policy since 2004, but had yet to finalise it, said Rural Health Advocacy Project manager Marije Versteeg. The policy should stipulate that rural hospitals in underserved areas should be prioritised for the allocation of community service doctors, and that no community service doctor should be placed in urban hospitals that were training interns.

"Among the doctors there is a strong sense that people should not be forced to work in rural areas. If you do, you will lose them forever," said Versteeg.

Reid acknowledged that the department had introduced financial incentives for rural doctors, but said this was not enough.

The health department's deputy director-general for human resources, Percy Mahlathi, declined to comment, saying that he was unable to obtain the information he needed for an interview as staff were on leave until next month.