training for retention in the boland/overberg region

Training for Retention in the

Boland/Overberg Region

Department Gesondheidswetenskappe ••••

Faculty of Health Sciences

Helise Schumann and Therese Fish

September 2010

Agenda

• Nursing college

• Rural Clinical School

Faculty of Health Sciences Tygerberg Academic HospitalMajor Teaching Hospital

Stellenbosch Health Sciences Faculty revisited strategy at beginning of 21st century – 50% of clinical training of Undergraduate students outside the Central Hospitals

with at least 10% in a rural setting

Worcester

Regional Hosp

CHC

Hermanus

SwellendamCaledon

Bredasdorp

Ceres

Robertson

Montagu

Stellenbosch University

Health Sciences Faculty

Boland Overberg Training Complex

Citrusdal

Malmesbury

Minister of Health 10-point plan

1.1. Improving the health profile of all South AfricansImproving the health profile of all South Africans

2.2. Provision of Strategic Leadership and creation of a Social Provision of Strategic Leadership and creation of a Social Compact for better health outcomesCompact for better health outcomes

3.3. Implementation of the National Health Insurance (NHI) and Implementation of the National Health Insurance (NHI) and improving the Quality of Health Servicesimproving the Quality of Health Services

4.4. Overhauling the health care system and improve managementOverhauling the health care system and improve management

5. Improved Human Resources Planning, Development and 5. Improved Human Resources Planning, Development and Management

6.6. RevitalisationRevitalisation of infrastructureof infrastructure

7.7. Accelerate implementation of the HIV & AIDS and Sexually Accelerate implementation of the HIV & AIDS and Sexually Transmitted Infections National Strategic Plan, increase focus Transmitted Infections National Strategic Plan, increase focus on TB and other communicable diseaseson TB and other communicable diseases

8.8. Mass Mass mobilisationmobilisation for better health for the populationfor better health for the population

9.9. Review of Drug PolicyReview of Drug Policy

10.10.Strengthen Research and DevelopmentStrengthen Research and Development

Inequitable Distribution of Health Professionals

We train health

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

environmentsNational Geographic National Geographic Dec 2008 Dec 2008

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 • 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%

Midwifery Course(1 year)

Post-Graduate Coursee.g. Theatre Technique

(1 year)

“Step Ladder” Approach to “Step Ladder” Approach to Formal NursingFormal Nursing

Auxiliary Nurse Course(1 year)

18.2 learners (community)

Enrolled Nurse Course(1 year)

Bridging Course toRegistered Nurse

(2 years)

18.1 learners (employees of WCPA – level 2)

Auxiliary nurses that trained for 100 days before 1993

18.2 learners (community)

18.1 learners (service)

Department

of HealthWorcester Hospital

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 candidatessuccessful 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

Learners trained since 1997Learners trained since 1997AUXILIARY NURSE AND UPGRADING

10 1218

2329

4541

27

40

47

37

12

2116

19

33 33

1920

30

40

50

TO

TA

L LE

AR

NE

RS

Auxiliary Nurse

Upgrading

Department


8 10 12129

0

10

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

YEARS

TO

TA

L LE

AR

NE

RS

Learners trained since 1999 Learners trained since 1999 19971997…continued…continuedENROLLED NURSE AND BRIDGING TO

REGISTERED NURSE COURSES

14

42 40 40 41 40

14

24

17202530354045

TO

TA

L LE

AR

NE

RS

Enrolled Nurse

Bridging to

Department


25

9 914

71010 9 7 9

5 7 914

05

101520

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

YEARS

TO

TA

L LE

AR

NE

RS

Registered Nurse

These learners are in their These learners are in their fourth year and will become fourth year and will become

professional nurses at the end professional nurses at the end of this year. They were all of this year. They were all

unemployed members of the unemployed members of the Boland and Overberg Boland and Overberg

communities.communities.

Learners busy with formal trainingLearners busy with formal training

Department


Learners busy with formal training Learners busy with formal training ……continuedcontinued

Department


The Establishment of a Rural

Clinical School

Department Gesondheidswetenskappe ••••

Faculty of Health Sciences

Vision of Stellenbosch University: HOPE Project

• The HOPE project launched by our Rector in July 2010.

• 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

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

International Experience

• Australia

• 14 RCS’s attached to 12 Medical Schools

• Parallel Rural Community Curriculum: students spent one year attached to a 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.

International Experience

• RPAP in Minnesota 9 months rural exposure

• 1971-2008

• 1000 students

• 66% FM careers

• >50% stay in rural locations• >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

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 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

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 • To acculturate undergraduate students into rural lifestyle

• Res

• Increase in number of graduates choosing to practice their career in a rural/underserved communities

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 • 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”)

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 experienceexperience

3. Enable continuity with patients for better learning4. Enable continuity with the mentor for better

guidance and supervision5. Enable continuity with a specific community for

better service orientation and contextualization of health problems

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 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

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 • 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

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 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

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

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

HUMAN SECURITY DEVELOPMENT

Increased availability of foodresources

COLLABORATION

management and leadership• Mentorship programmes for new

entrant farmers• Increased amount of fresh produce in

rural areas [USAID]

Establishment ofRURAL SUSTAINABILITY INSTITUTE

• Involvement of various faculties with key projects which support sustainability

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

Water

Health

Lifestyle improvements

Skills development

Environmental sustainability

COLLABORATION

Acknowledgement: Prof B Marais & Ukwanda staff

Ngiyabonga!Ngiyabonga!

Ke ya leboha!Ke ya leboha!

Ndiyabulela!Ndiyabulela!

Thank you!Thank you!

DankieDankie!!

Department


training for retention in the boland/overberg region

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