oa South African Health Review - 20 Years of community service in South Africa: what have we learnt? - review

Volume 2018 Number 1
  • ISSN : 1025-1715



T he Health Professions Amendment Act No. 56 was signed into law by President Nelson Mandela in 1998, beginning a system of mandatory community service in the public health sector for all health professionals in South Africa. The first cohort of doctors began their year-long service in July 1998, followed by a much larger cohort in January 1999. All other categories of health professionals followed in successive years, with the largest cohort of professional nurses joining in 2005. This chapter draws on numerous published and unpublished studies of community service, including annual exit surveys initiated by the Department of Health. The initial development of the programme is described as well as observed trends in the experiences of community service officers, and the effect of community service on the health services since its inception in 1998. The policy is analysed in terms of its stated objectives, the process of policy development, initial implementation, and the operational challenges that have arisen due to fiscal constraints and the difficulty that provinces face in funding sufficient posts for community service officers. Implementation of the community service policy has varied considerably, especially because of the absence of national guidelines for provincial departments. Compulsory CS is an effective strategy for recruiting health professionals to rural and underserved areas, but it is ineffective in retaining them in the absence of complementary longer-term human resource interventions.

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