Recruitment and retention strategies for public sector optometrists in KwaZulu-Natal Province, South Africa

Abstract

Background: In South Africa, there is a paucity of optometrists serving the needs of the larger public sector. KwaZulu-Natal is one of the most densely populated provinces and home to several of the poorest districts. Despite an optometry school in the province, and with a lack of compulsory community service for new graduates, more optometrists are needed to serve the public sector. While studies on the recruitment and retention of medical and allied health professionals have been conducted, limited evidence exists on work trends of public sector optometrists. Methods: A cross-sectional study design using both quantitative and qualitative data collection methods was used. All public sector optometrists and local district health co-ordinators in the province were contacted, with an 80% (41 out of 51) and 75% (9 out of 12) response rate, respectively. Questionnaires containing demographic, recruitment, retention and open-ended questions were distributed by post, fax and email and via an online survey to both groups. Telephonic interviews were also conducted using semi-structured techniques. Frequency distributions, Fisher’s exact test and odds ratios were used to statistically describe the demographic data, while qualitative responses were recorded and analysed for commonly occurring themes. Results: The present public sector optometry workforce comprises mainly young (73%), black (70%), women (66%). They chose to work in the public sector to ‘make a difference’ and were attracted by ‘good working hours’ and ‘job security’. Fifty-three percent of optometrists work in the public sector due to a study bursary, for which there was a statistically significant association for race (p = 0.01), gender (p = 0.05) and background origin (p = 0.05). To aid their retention in public service, improved salaries, career progression, recognition, improved management relations and improved instrumentation were ranked highest by these optometrists. Conclusion: The demographic profile of presently serving public sector optometrists poses many human resource (HR) challenges and opportunities. Universities should pay attention to rural origin of students and provide exposure to rural clinical experiences during study. Departments of Health use study bursary incentives to recruit optometrists, but need to consider financial and non-financial incentives for their retention. At hospital level, a responsive HR management system should be implemented with emphasis on career management, recognition, improving infrastructure and supporting professional development.