Africa/eastern cape

In working to bridge these gaps, the Practice Managers have made definite impacts on the cilities, managers and doctors they support. Included here are three examples (one in each district) of the work being done through the Eastern Cape Rural Doctor Support Programme.

·Ukhahlamba (11)

The Practice Managers have successfully provided support in a number of areas, including HR capacity development, procurement, training, accommodation, basic administrative support for doctors and managers, and doctor/manager relations. According to AHP’s monitoring and evaluation department, the CPD sessions have proved to play a crucial role in reducing the level of professional isolation felt by many of the doctors while working in these rural cilities. In addition to CPD sessions, the Practice Managers are due to start working on a mentorship programme to further reduce isolation by rural doctors.

Ukhahlamba District. A doctor at Cloete Joubert Hospital, has been employed as a 30 hour sessional doctor since 2004. However, despite numerous appeals, her salary had not been increased since her sessional work began. The hospital CEO agreed that this was unir and that she needed to be treated as a permanent employee or the hospital would lose her services. In an urgent attempt to retain this doctor, the Practice Manager followed up on previous communications and eventually got confirmation from the ECDOH Superintendant General’s office that all outstanding payments to the doctor would be made in April 2011. It is in this final district where the DMT manager is fully engaged with AHP and is a valuable asset to ensuring that the project works.

There are a wide range of issues that the Practice Managers encounter on a daily basis – these include a lack of team work, poor infrastructure, centralisation of operations and bad rAfrica/eastern capeoads. All three Managers have explained that the issue of poor infrastructure (i.e. old buildings that need renovations, obsolete equipment, lack of decent accommodation for doctors, and a general shortage of medical supplies) is the most frequent issue they encounter.

Below is a link to an article published by the SAMJ prior to the launch of the Rural Support Programme in April 2010 (SAMJ, S. Afr. med. j.vol.100no.4Cape TownApr.2010):

The Eastern Cape is comprised of the following districts (Port Elizabeth being a metropolitan district) – see map:

·Alfred Nzo (13)

·Amatole (9)

·Port Elizabeth Metro (7)

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In total, the programme currently supports 43 remote level 1 cilities across the three districts. In addition to visits to district and provincial offices, the Practice Managers have conducted almost 160 separate cility visits. On average, in the first few months of the project, 75% of cilities have been visited at least three times.

·Cacadu (8)

In the coming months AHP’s Practice Managers will be increasing the programme’s spending on minor equipment, repairs and consumables for hospitals. Additionally, the Managers will begin to implement the mentorship element of the programme now that relationships have been successfully established. CPD sessions will continue to be held at a rate of two per district per month, but the range of topics will expanded and the sessions themselves will become more interactive. Finally, methods to reach sustainable interventions will be investigated in order to ensure the longevity of the project.

·Monitoring and evaluation of programs/campaigns/sections

Our Practice Managers operate as follows: Funani Ntontela in the Chris Hani District, Jonathan Holborn in OR Tambo, and Hluma Zakaza in Ukhahlamba (now officially called Joe Gqabi District). These three accomplished and enthusiastic Practice Managers actively build relationships and provide support through hospital visits. They develop relationships with doctors and other medical staff in all hospitals in their districts and arrange regular CPD sessions for rural doctors. They additionally assist doctors with administrative problems, assist hospital managers with minor equipment repairs and purchases, profile hospitals for AHP and build relationships with management.

This support programme is ultimately operating with the aim to alleviate the needs of rural healthcare cilities through improving access to learning opportunities in the form of continued professional development (CPD); cilitating improved communications between management and clinicians at all levels; assisting cility management with minor equipment and repairs; providing access to experienced mentors and organising as well as promoting networking events and knowledge sharing opportunities.

This area is beautiful and has potential to attract good doctors given the right infrastructure and management of hospitals.

·Decent human resource support systems

Chris Hani District. A doctor in Elliot Hospital mentioned to the Practice Manager that certain medical equipment was old and ulty, including ECG and BP machines. This equipment had been sent for repairs but that there was a delay in returning them to the hospital. The Practice Manager liaised with the procurement officer, DOH staff at a district level, as well as directly with Siyakhanda Medical Services. The repaired equipment was returned to the hospital, where they were desperately needed, in a matter of days and are currently in full use.

·Backlogs at district and provincial level not being prioritised

·Chris Hani (10)

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OR Tambo District. A community service pharmacist at Sipetu Hospital, handed in his resignation and was looking for work elsewhere, despite wanting to continue working at the cility beyond his community service obligation. His official appointment had been blocked at a provincial level due to a missing signature and other incorrect documentation. The Practice Manager convinced the pharmacist to stay, had the appointment st tracked by drafting a letter on behalf of the hospital CEO, and got this signed expeditiously by the District Manager so that the appointment process could be finalised. He is now being retained permanently at Sipetu and plans to stay on indefinitely.

·OR Tambo (12)

January saw the beginning of the Eastern Cape Rural Doctors Support Programme, which was implemented by Africa Health Placements (AHP) in partnership with the Eastern Cape Department of Health. The programme is being supported by Dr. Tim Wilson (project manager), Limont Lehman of AHP (project manager) and Dr. S. Pillay (Superintendent General for the Eastern Cape Department of Health). The project is intended to enhance the professional lives of both doctors and managers in rural settings and has proved to be working wonders for the rural communities serviced. Interventions under this programme are ultimately aimed at retaining more doctors in rural public service.

·Skills development for management and district admin staff

·Inadequate infrastructure at hospitals for patients as well as for the healthcare professionals working there

·Poor administration

Overall, the most common gaps that the Practice Managers encounter are:

Africa/eastern cape,The first phase of the support programme is taking place in three districts in the Eastern Cape with the help of three Practice Managers. These districts are Ukhahlamba, Chris Hani and OR Tambo, (3 of the 6 non-metropolitan districts in the province) and, depending on results, the project is set to expand into another district within the next year.

One of the Practice Managers perhaps explains it best:

Even though this project has only been running for several months, the results are amazing and speak for themselves. Achievements in this vein include: established working relationships between the Practice Managers and District Managers in all three districts, working relationships in all of the remote level 1 cilities and 9 fully accredited CPD sessions completed (3 per district).

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