title: What interventions do South African qualified doctors think will retain them in rural hospitals of the Limpopo province of South Africa?
abstract: BACKGROUND
  In South Africa, the health system faces a variety of problems, such as an overall shortage of and misdistribution of healthcare workers. The Department of Health in South Africa has attempted to address the shortage of rural doctors by introducing various interventions, including an increase in salaries, introduction of scarce skills and rural allowances, the deployment of foreign doctors, and upgrading of clinics and hospitals. Despite these, the maldistribution of doctors working in South Africa has not improved significantly. This attests to the multifactorial nature of this problem and to the fact that intensive and sustained efforts are needed to rectify it. Few South African studies have been undertaken to establish the needs of rural doctors in South Africa and to seek possible solutions to their problems. While a number of studies have identified some of the major problems, much still needs to be done. Innovative ways to address this crisis are urgently needed. The main objectives of this study were to identify interventions as proposed by doctors in the rural Limpopo province of South Africa and to develop recommendations based on these.
  
  
  METHODS
  This study utilised a descriptive qualitative design using a semi-structured questionnaire. Ten doctors from rural hospitals within all six districts of the Limpopo province were randomly selected and interviewed.
  
  
  RESULTS
  Themes recommended included: increasing salaries and rural allowances; improving rural hospital accommodation; ensuring career progression; providing continuing medical education; increasing support by specialist consultants; improving the physical hospital infrastructure and rural referral systems; ensuring the availability of essential medical equipment and medicines; strengthening rural hospital management and increasing the role of doctors in management; improving the working conditions; establishing private-public collaborations with private general practitioners; increasing rural doctors' leave allocations; ensuring adequate senior support for junior doctors; improving rural hospital environments and providing recreational facilities; assisting rural doctors' families, and providing recognition and appreciation for the work rural doctors do.
  
  
  CONCLUSIONS
  The resolution of one isolated factor without improving the host of push factors currently present in the health system is unlikely to lead to significant improvements in the retention of rural doctors. The results of this study can be used to assist the Limpopo Department of Health to identify the most pressing needs of rural doctors in the province. A number of interventions are suggested by rural doctors that they feel would retain them in their current rural practices. The recommendations include various interventions involving different levels of the healthcare system. It also recommends an incentive package for doctors willing to serve longer term in rural hospitals.
authors.affiliation: Rural Aids Development and Action Research Program, Tintswalo Hospital, Acornhoek, Limpopo Province, South Africa. tjkotzee@soft.co.za
authors.forename: Theunis J
authors.initials: TJ
authors.lastname: Kotzee
authors.forename: Ian D
authors.initials: ID
authors.lastname: Couper
mesh_terms: D000328:Adult; D002322:Career Mobility; D004502:Education, Medical, Continuing; D005260:Female; D019538:Health Care Surveys; D006272:Health Facility Environment; D006780:Hospitals, Rural; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008297:Male; D010563:Personnel Turnover; D010820:Physicians / Q000600:supply & distribution*; D036301:Qualitative Research; D012456:Salaries and Fringe Benefits; D012944:Social Support; D013019:South Africa; D000078329:Workforce; D016526:Workload