Abstract

MATIWANE, B P; BLAAUW, D  and  RISPEL, L C. Perspectives of doctors, nurses and rehabilitation therapists in Gauteng and Mpumalanga provinces' public hospitals on remunerative work outside of the public service. SAMJ, S. Afr. med. j. [online]. 2025, vol.115, n.4, pp.29-35. ISSN 2078-5135.  https://doi.org/10.7196/SAMJ.2025.v115i4.2653.

BACKGROUND. The remunerative work outside of the public service (RWOPS) policy enables public sector health professionals to engage in multiple job holding (MJH) in South Africa (SA) under specified conditions, but remains controversial. Empirical evidence on health professionals' perspectives on the RWOPS policy stipulations is lacking. OBJECTIVE. To examine the perspectives of public sector medical doctors (MDs), professional nurses (PNs) and rehabilitation therapists (RTs) on the RWOPS policy. METHODS. In 2022, public sector MDs, PNs and RTs were surveyed in 14 Gauteng and 15 Mpumalanga province public sector hospitals. In addition to demographic and employment data, the self-administered questionnaire collected information on whether the health professionals had obtained permission for additional jobs, their opinions on RWOPS approval requirements and restrictions and the likelihood that they would leave the public sector if RWOPS was denied. Data analysis was performed using Stata 17. The factors influencing health professionals' perspectives on different aspects of the RWOPS policy were analysed using penalised logistic regression. RESULTS. A total of 1 397 health professionals completed the survey, for a response rate of 84.3%. Most MDs (61.1%) and RTs (60.5%) supported mandatory RWOPS approval, compared with 41.5% of PNs. Overall, 52.6% of MDs, PNs and RTs engaged in MJH also agreed with mandatory approval. Among those who engaged in MJH, the majority of MDs (84.7%) and RTs (87.4%) had RWOPS permission, compared with only 19.2% of PNs. MDs (odds ratio (OR) 9.9, p<0.001) and RTs (OR 30.9, p<0.001) were significantly more likely to obtain RWOPS approval than PNs. MDs (OR 2.2, p<0.001), RTs (OR 1.5, p=0.027), males (OR 1.4, p=0.039) and RWOPS participants (OR 2.8, p=0.030) were more likely to consider leaving if RWOPS was denied. CONCLUSION. Our findings highlight significant variation in obtaining MJH permission among health professionals. The diverse perspectives underscore the need for targeted communication and stakeholder engagement to clarify policy and improve compliance.

Keywords : RWOPS; multiple job holding; dual practice; regulation; health workforce.

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