Abstract
The Primary Health Care (PHC) approach to provide access to health care to all South
Africans was introduced in 1994. As one of the strategies to provide human resources for
health care in SA, the Department of Health (DOH) legislated Compulsory Community
Service (CCS) for health professionals in the Medical, Dental and Supplementary Health
Amendment Act of 1997 (Republic of South Africa, 1997), for health professionals who
wish to register their qualifications with the Health Professions Council of South Africa
(HPCSA). The Compulsory Community Service Policy for nurses was introduced in South
Africa and legislated in 2005 in the Nursing Act No 33 of 2005 (Republic of South Africa,
2006) and is guided by regulation on performance of community service, published in
Government Notice No. 765 of 24 August 2005. (SANC, 2021:1). Compulsory Community
Service for health professionals in South Africa has emerged as a symbol of commitment
by the health department and the medical establishment for equitable distribution of
health professionals, with emphasis on rural and underserved populations.
Compulsory Community Service for nurses commenced in South Africa in January 2008
after it was legislated in the new Nursing Act (Act No. 33/2005). The programme's aims
were to attract healthcare professionals to work in rural areas in the longer term after
qualifying in various fields (South African Nursing Council, 2005). Whilst health
institutions have welcomed the introduction of Compulsory Community Service, no
structured strategies have been developed to attain and retain community service nursing
professionals on completion of one year of compulsory community service, thereby
enhancing their benefit of the programme to the communities they serve.
The purpose of this study was to gain an understanding of the experiences of Community
Nursing Service Professionals during compulsory community service, to develop a
conceptual framework based on the experiences of Community Nursing Service
Professionals and to develop strategies to facilitate attaining and retaining Community
Nursing Service Professionals in the Primary Health Care facilities in Ekurhuleni Health
District, Gauteng Province.
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The objectives of this study were to explore and describe the experiences of the
Community Nursing Service Professionals working in the Primary Health Care facilities
in Ekurhuleni Health District: Gauteng Province; to develop and describe the conceptual
framework for the facilitation of a conducive environment for community service based on
the results of the experiences of Community Service Nursing Professionals, and to
develop and describe strategies to facilitate attaining and retaining Community Service
Nursing Professionals in the Primary Health Care facilities in Gauteng Province on
completion of the compulsory community service.
The research study was conducted in three phases. In Phase 1, the experiences of
Community Service Nursing Professionals placed at the Primary Health Care facilities
were explored and described. The population comprised of Community Service Nursing
Professionals, who have completed the R425 programme for registration as a nurse
(general, community and psychiatric) and midwives, who are placed for compulsory
community service as legislated by regulation R765 at the PHC facilities in Gauteng
Province. The Community Service Nursing Professionals were placed at the Ekurhuleni
Health District for community service in 2017.
A purposive sampling method was used in selecting the four-year trained professional
nurses placed for Compulsory Community Service, at the Primary Health Care facilities
in Ekurhuleni Health District: Gauteng Province. The sample included participants who
were willing to participate in the study.
A qualitative, exploratory, descriptive, and contextual research design was utilised. Indepth,
individual, phenomenological and focus group interviews were conducted with the
participants. Data analysis was conducted using Giorgi’s phenomenological descriptive
data analysis method and applying Giorgi stages of data analysis. Literature control was
conducted to contextualise the research results with relevant national and international
literature. In Phase 1, two themes were identified during data analysis. Theme 1: the
Community Service Nursing Professionals experienced an environment not conducive to
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rendering quality care and four categories emerged from the findings. In Theme 2, the
Community Service Nursing Professionals experienced a work environment that
influenced their professional potential and three categories emerged from the findings. In
Phase 2, the conceptual framework was developed and described from the results of
Phase 1. The researcher used Dickoff, James and Wiedenbach's (1968:423) survey list:
Who is the agent? Who is the recipient? What is the procedure? What are the dynamics?
What is the context? What is the outcome? The researcher's mental map served as the
basis for development of the conceptual framework.
In Phase 3, the strategies to facilitate attaining and retaining the Community Service
Nursing Professionals in the Primary Health Care facilities on completion of community
service were developed and described. Strategy 1 focused on strengthening the working
relationship between the Deputy Directors, Assistant Directors, Nursing Service
Managers, Primary Health Care: Professional Nurses and Community Service Nursing
Professionals. Strategy 2 focused on facilitation of the working phase (implementation of
activities to facilitate an environment conducive to rendering quality care. Strategy 3
focused on facilitating and addressing the Community Service Nursing Professionals
experienced work environment influencing their professional potential.
The evaluation of strategies was conducted with a panel of Deputy Directors, Assistant
Directors, Nursing Service Managers, and the Primary Health Care: Professional Nurses
with extensive experience in primary health care services and compulsory community
service policy. The research process adhered to measures of trustworthiness, including
upholding ethical principles throughout the research process.
The research study presented the researcher’s undertaking to understand the
experiences of Community Service Nursing Professionals, during community service
as the point of entry into the Health Care System and the significance of attaining and
retaining Community Service Nursing Professionals, to ensure quality care. The
strategies will serve to influence nursing education, nursing practice, future nursing
research and policy guidelines to improve the rendering of quality care.
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Keywords: Attaining and Retaining, Community Service, Community Service Nursing
Professionals, Facilitation, Primary Health Care, Strategies