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Journal of Public Health Policy

, Volume 32, Supplement 1, pp S80–S93 | Cite as

Analyzing the implementation of the rural allowance in hospitals in North West Province, South Africa

  • Prudence DitlopoEmail author
  • Duane Blaauw
  • Posy Bidwell
  • Steve Thomas
Original Article

Abstract

Using a policy analysis framework, we analyzed the implementation and perceived effectiveness of a rural allowance policy and its influence on the motivation and retention of health professionals in rural hospitals in the North West province of South Africa. We conducted 40 in-depth interviews with policy-makers, hospital managers, nurses, and doctors at five rural hospitals and found weaknesses in policy design and implementation. These weaknesses included: lack of evidence to guide policy formulation; restricting eligibility for the allowance to doctors and professional nurses; lack of clarity on the definition of rural areas; weak communication; and the absence of a monitoring and evaluation framework. Although the rural allowance was partially effective in the recruitment of health professionals, it has had unintended negative consequences of perceived divisiveness and staff dissatisfaction. Government should take more account of contextual and process factors in policy formulation and implementation so that policies have the intended impact.

Keywords

rural allowance policy analysis motivation retention health professionals South Africa 

Notes

Acknowledgements

The study was funded by Irish Aid and administered through the Health Research Board in Ireland. We would like to thank all study participants.

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Copyright information

© Palgrave Macmillan, a division of Macmillan Publishers Ltd 2011

Authors and Affiliations

  • Prudence Ditlopo
    • 1
    Email author
  • Duane Blaauw
    • 1
  • Posy Bidwell
    • 2
  • Steve Thomas
    • 2
  1. 1.Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, University of the WitwatersrandWitsSouth Africa
  2. 2.Centre for Health Policy and Management, Trinity CollegeDublinIreland

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