Retention of medical officers in district health services, South Africa: a descriptive survey

BACKGROUND: The health workforce is critical to strengthening district health services (DHS). In the public sector of South Africa, medical officers (MOs) are essential to delivering services in primary health care (PHC) and district hospitals. Family physicians, responsible for clinical governance, identified their retention as a key issue. AIM: To evaluate factors that influence retention of MOs in public sector DHS. DESIGN & SETTING: A descriptive survey of MOs working in DHS, Western Cape, South Africa. METHOD: All 125 MOs working in facilities associated with the Stellenbosch University Family Physician Research Network (SUFPREN) were included in the survey. A questionnaire measured the prevalence of key factors that might be associated with retention (staying >4 years) and included the Satisfaction of Employees in Health Care (SEHC) tool and Short Warwick–Edinburgh Mental Wellbeing Scale (SWEMWBS). Data were collected in Research Electronic Data Capture (REDCap) and analysed in the Statistical Package for Social Sciences (SPSS). RESULTS: Ninety-five MOs completed the survey. The overall rating of the facility (P = 0.001), age (P = 0.004), seniority (P = 0.015), career plans (P<0.001), and intention to stay in the public sector (P<0.001) were associated with retention. More personal factors such as social support (P = 0.007), educational opportunities for children (P = 0.002), and staying with one’s partner (P = 0.036) were also associated with retention. Sex, rural versus urban location, district hospital versus primary care facility, overtime, remuneration, and additional rural allowance were not associated with retention. CONCLUSION: The overall rating of the facility was important and subsequent qualitative work has explored the underlying issues. These findings can guide strategies in the Western Cape and similar settings to retain MOs in the DHS.