RURAL ALLOWANCE STUDY

The Rural Allowance (RA) was implemented in March 2004, and the study was the first attempt to assess the impact that it has had on the motivation and movement of health professionals working in rural areas. The impact of the initial R500 million allocated by the state Treasury in July 2003 to the RA, needed to be measured in order to objectively evaluate whether it is a worthwhile investment — hence the study.

The RA was a national initiative instituted by the Minister of Health. It aimed to address the problem of the maldistribution of health professionals between rural and urban areas in South Africa. Financial and non-financial incentives have been used in other countries to recruit and retain health professionals in areas of need, and in 1994 a Rural Recruitment Allowance was instituted in South Africa. However, this allowance was granted only to medical doctors and dentists, and remained at the same fixed rate since the time of its inception. It was perceived to be ineffective as an incentive for the retention of professional staff. Despite the introduction of community service for all health professionals except nurses, it remains difficult to recruit and retain professional staff at rural hospitals, health centres and clinics.

243 health professionals from a random sample of thirty-four designated rural hospitals were surveyed in November 2003, before the introduction of the RA, and 289 respondents were surveyed in the same hospitals in May 2004, two months after the RA was introduced. Although methodologically limited, the study shows that almost one third of health professionals working in rural areas said that they changed their career plans for 2005 as a result of the RA's inception. It is difficult to assess whether this is the effect of the RA alone, or in combination with the Scarce Skills Allowance (SSA). (The SSA benefits certain categories of health professional regardless of their place of work.) Further evaluations are necessary to assess the longer-term impact of these strategies.

The changing nature of the RA made the planning of the research project difficult, as there was intense and lengthy debate in the Public Service Bargaining Chamber regarding the exact nature of this allowance, who it would benefit, and most importantly, who would be excluded. The data collected for the baseline survey did not anticipate the simultaneous introduction of the SSA, which was confused by some of the respondents and their managers as the RA. Nevertheless, an attempt was made to capture information as the process unfolded, in order to have a baseline on record for future evaluations.

While the effect of the RA may eventually be seen in staffing patterns of rural hospitals, the longer-term effect is likely to be diluted by the many other factors that influence health professionals' career choices apart from financial benefits. It was therefore important that the effect of the RA was measured in the short term by direct questioning of those receiving it, in order to control these variables as far as possible, and allow a more direct evaluation of the intervention.