HEALTH PERSONNEL NEEDS AND ATTITUDES TO RURAL SERVICE IN KWAZULU-NATAL

Objectives. To ascertain the urban/rural distribution of health person nel and the opinions of the medical fraternity in KwaZulu-Natal on com pulsory rural service for medical practitioners. Design. Cross-section al analysis of geographical distribution of health personnel in KwaZul u-Natal based on 1991/92 South African Medical and Dental Council, Sou th African Nursing Council and Pharmacy Council registration data. Opi nion survey by administration of a structured questionnaire to a simpl e, random sample of private practitioners, academic consultants, postg raduate and undergraduate medical students and key informants in senio r health service management in KwaZulu-Natal. Results. Peripheral rura l areas had health personnel/population ratios higher than or equivale nt to those of urban areas, whereas the ratios were 15 - 40 times lowe r in deep rural areas, The key finding of the opinion survey was that the majority of all sectors except fifth-year medical students felt th at rural service should be compulsory, either post-internship, prior t o specialisation or prior to,entry into private practice, However, res pondents were significantly more likely to agree to rural. service tha t would not affect them personally, The majority (54 - 87%) of all sec tors felt that an option of 'buying out' of rural service should not b e permitted, Respondents identified a range of financial, health servi ce, academic, infrastructural and social incentives for rural practice , It is recommended that post-internship rural service be compulsory f or a period of 6 months to 1 year provided that academic, health servi ce and infrastructural deficiencies are ameliorated and appropriate fi nancial incentives are provided.