Training for Retention in the Boland/Overberg Region

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1 Training for Retention in the Boland/Overberg Region Helise Schumann and Therese Fish September 2010 Department Gesondheidswetenskappe Faculty of Health Sciences

2 Agenda Nursing college Rural Clinical School

3 Faculty of Health Sciences Tygerberg Academic Hospital Major Teaching Hospital Stellenbosch Health Sciences Faculty revisited strategy at beginning of 21 st century 50% of clinical training of Undergraduate students outside the Central Hospitals with at least 10% in a rural setting

4 Citrusdal Health Sciences Faculty Malmesbury Ceres Montagu Worcester Regional Hosp CHC Robertson Stellenbosch University Hermanus Caledon Bredasdorp Swellendam Boland Overberg Training Complex

5 Minister of Health 10-point plan 1. Improving the health profile of all South Africans 2. Provision of Strategic Leadership and creation of a Social Compact for better health outcomes 3. Implementation of the National Health Insurance (NHI) and improving the Quality of Health Services 4. Overhauling the health care system and improve management 5. Improved Human Resources Planning, Development and Management 6. Revitalisation of infrastructure 7. Accelerate implementation of the HIV & AIDS and Sexually Transmitted Infections National Strategic Plan, increase focus on TB and other communicable diseases 8. Mass mobilisation for better health for the population 9. Review of Drug Policy 10.Strengthen Research and Development

6 Inequitable Distribution of Health Professionals In SA, ~40% of population stay in Rural Areas We train health professionals in well resourced city/urban areas and except them to work in resourced constrained environments National Geographic Dec 2008

7 Becoming a learning organisation Worcester hospital had some challenges over the years in recruiting and retaining health care professionals for longer periods. To address this one of the strategic objectives of Worcester hospital is being Employer of choice where people would like to work, have opportunities to develop themselves and become a learning organisation In 1996 a decision was made to start our own nurse training program to supply in our own demand and that of the region we serve. Over the years that this program has been running, we found that rural origin students are far more likely to stay when they train in their own area. 70% of all nurses employed in the Geographical service area of Worcester hospital went through some aspect of our training program The hospital does not make use of any agency staff and has a nurse vacancy rate of 1,5%

8 Step Ladder Approach to Formal Nursing Post-Graduate Course e.g. Theatre Technique (1 year) Midwifery Course (1 year) Bridging Course to Registered Nurse (2 years) Enrolled Nurse Course (1 year) 18.1 learners (service) 18.2 learners (community) Department of Health Auxiliary Nurse Course (1 year) Auxiliary nurses that trained for 100 days before learners (employees of WCPA level 2) 18.2 learners (community) Worcester Hospital

9 Recruitment and selection process Needs analysis of Regional Hospital as well as district Hospitals in the Geographic service area Advertisement in local newspapers in July of the previous year Paper selection and literacy & numeracy testing of successful candidates Group interviews in the town where students are recruited from Local Community leaders are part group interview process Final selection of student intake for the following year according to available funding

10 Learners trained since 1997 AUXILIARY NURSE AND UPGRADING TOTAL LEARNERS Auxiliary Nurse Upgrading YEARS Department of Health Worcester Hospital

11 Learners trained since continued ENROLLED NURSE AND BRIDGING TO REGISTERED NURSE COURSES TOTAL LEARNERS Enrolled Nurse Bridging to Registered Nurse YEARS Department of Health Worcester Hospital

12 These learners are in their fourth year and will become professional nurses at the end of this year. They were all unemployed members of the Boland and Overberg communities.

13 Learners busy with formal training Department of Health Worcester Hospital

14 Learners busy with formal training continued Department of Health Worcester Hospital

15 The Establishment of a Rural Clinical School Department Gesondheidswetenskappe Faculty of Health Sciences

16 Vision of Stellenbosch University: HOPE Project The HOPE project launched by our Rector in July At Stellenbosch University, we believe that we are true builders of hope on the African continent, that we are set to blaze new trails with our science for society strategy and that we can take on some of the world's toughest challenges by putting our strengths and expertise at the service of human need. The University has thus positioned itself as a builder of hope by aligning its core activities with the following development themes from the international Millennium Development Goals: Eradicating poverty and related condition Promoting human dignity and health Promoting democracy and human rights Promoting peace and security Promoting a sustainable environment and a competitive industry

17 Education and Training Strategic initiatives are aimed at maintaining and enhancing Faculty levels of excellence with a teaching and training model that is community oriented and focused on Primary Health Care Interdisciplinary Learning Community Orientated Teaching and Rural Training 17

18 Australia International Experience 14 RCS s attached to 12 Medical Schools Parallel Rural Community Curriculum: students spent one year attached to a rural GP These students report increased clinical exposure to common conditions as well as procedures in comparison with students in tertiary hospitals.

19 International Experience RPAP in Minnesota 9 months rural exposure students 66% FM careers >50% stay in rural locations WWAMI program in Seattle Washington, Wyoming, Alaska, Montana, Idaho 60% of students stay in these states 50% in remain in primary care

20 Why a rural clinical school? Rural origin students more likely to return to practice in rural communities Exposure to good rural training experiences and learning opportunities influences career choices Career decisions influenced by meaningful engagement from experience related to time and connection to local people as a result of time spent in the community Are tertiary hospitals still appropriate places to train students? In the WC only 1-2 % of patients are treated in tertiary hospitals

21 Philosophy of the RCS concept Australian and North American health policy makers responded to their rural staffing crisis by establishing Rural Clinical Schools Aim: To acculturate undergraduate students into rural lifestyle Res Increase in number of graduates choosing to practice their career in a rural/underserved communities

22 Advantages of a RCS Model for generalist training responsive to SA needs Senior undergraduate students and registrars would be involved in service learning in the area and as such contribute to services Academic stimulus to rural practitioners involved in teaching and simultaneously improving the quality of care in rural areas (part of continuous professional development) Support research relevant to the health needs of rural and underserved communities Testing the potential usefulness of rural exposure in an African context ( pilot site )

23 RCS 10 guiding principles 1. Recruit students from rural areas to encourage future retention 2. Teach where the patients are to ensure relevant exposure to the burden of disease and practical experience 3. Enable continuity with patients for better learning 4. Enable continuity with the mentor for better guidance and supervision 5. Enable continuity with a specific community for better service orientation and contextualization of health problems

24 RCS Seminar -10 guiding principles 6. Catalyze research in a rural context as the research base is limited 7. Support multi-professional learning to foster teamwork 8. Make use of IT solutions to overcome geographic distances 9. Promote a community orientated approach / community engagement / sense of responsibility for a defined population 10. Enable longer exposure to the district health system so that service learning becomes a win-win for both

25 Stellenbosch Context Currently >1096 students rotate through various rural sites all short rotations with longest being 5 weeks in Family Medicine In 2011, 13 final year MBChB students will spend either one year at the regional hospital rotating through traditional rotations or spending one year under the guidance of a Family physician with input form regional hospital general specialists Most of these students have had a previous exposure to a rural rotation or come from a rural area Still concerns from specialists in tertiary complex in respect of veering from traditional model Positive input from rural colleagues to understand the curriculum and help to adjust the process to ensure outcomes for a medical student are met

26 Going forward Increased Focus on inter-professional education Increase rural exposure for other UG professions OT, Physiotherapy, Speech and Language, Dietitics Process in place to consider how we accommodate rural origin into our selection criteria Review selection criteria Bursary scheme in region with PGWC as partner. First medical student qualifying this year. Second student joining RCS next year. Quota of rural students selected in 1st year for rural cohort Need for clinical supervisors Development of service models which incorporate students as part of the team in a sustainable way Tracking system of our graduates

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29 STELLENBOSCH UNIVERSITY RURAL PLATFORM A leverage for Sustainable Rural Development RURAL AGRICULTURE INITIATIVE Boosting rural agricultural science and technology increased productivity and growth increased economic growth in region Empower local farmers to obtain improved access to finance Enhancing human capital through education and improved health Short courses in agricultural practice, management and leadership Mentorship programmes for new entrant farmers Increased amount of fresh produce in rural areas [USAID] COLLABORATION HUMAN SECURITY DEVELOPMENT Increased availability of food resources Water Health Lifestyle improvements Skills development Environmental sustainability RURAL CLINICAL SCHOOL EDUCATION AND TRAINING Undergrad students (2009: 50 students) Postgraduate students (2010: 20 students RESEARCH AND EPIDEMIOLOGY INTERVENTION Burden of disease Studies and interventions: TB, HIV/AIDS, Diabetes, Cancer, Cardiovascular & Respiratory diseases COMMUNITY DEVELOPMENT CENTRE Community nutrition initiatives (including dietary education) Outreach & home visits (including education) Community Interaction projects (improvement of health care infrastructure; improving lifestyles of patients through awareness and education) EMPOWERMENT OF COMMUNITY Skills training, development Ownership of health responsibility Establishment of RURAL SUSTAINABILITY INSTITUTE Involvement of various faculties with key projects which support sustainability COLLABORATION Acknowledgement: Prof B Marais & Ukwanda staff

30 Ngiyabonga! Ke ya leboha! Ndiyabulela! Thank you! Dankie! Department of Health Worcester Hospital