Community-service dieticians in South Africa face an array of challenges

By Rejoice Shumba [1]

Dieticians completing compulsory community service are experiencing problems with the structure of the programme and their own professional role as well as the nature of the job. These are some of the findings from recent research into the one-year compulsory community service for dieticians, introduced by the South African Department of Health in 2003.

Compulsory community service for health professionals, which started with compulsory community service for doctors in 1997, was introduced as a way to combat the problem of low service delivery in under-served areas, including rural areas, and to attract and retain professionals in them. In return, the health professionals are provided with a chance to improve their skills, knowledge, critical thinking and behaviour.

The challenges to compulsory community service dieticians

Marie Paterson, who has just completed her PhD on community service among dieticians, identified three thematic problem areas amongst compulsory community service dieticians [2]:

Structural and facility problems

  • lack of supervision and support;
  • lack of preparedness of the receiving institution and of the community service dieticians themselves;
  • lack of basic facilities and resources;
  • bureaucratic problems and poor hospital administration;
  • breakdown in communication.

Problems with professional role

  • lack of understanding of the community services dieticians' role by others;
  • under-utilisation of dietetic services and lack of recognition; and
  • not being part of a team.

Nature of the job

  • work/role overload;
  • anti-retroviral programme overload;
  • cultural barriers;
  • remoteness;
  • lack of promotional prospects and remuneration; and
  • family and travel issues.


Although some of the problems, such as cultural barriers and remoteness of the areas in which the dieticians are serving, are relatively difficult to solve, the research suggests that the majority of the problems are structural and can be addressed by the Department of Health or the hospital administration. According to the study, these include lack of supervision and support, shortage of basic facilities and resources, as well as poor hospital administration.

In the article by Paterson, Green and Maunder [3] it was recommended that the problem of the lack of preparedness by receiving institutions should be made a priority. They further recommend that training institutions should be more proactive in preparing dietetic students for community service.

Relationship with other health professionals

The community service dieticians felt that they were not appreciated by other medical professionals in the hospitals where they were deployed. They also felt that their skills were not being fully utilised. One of the respondents mentioned that:

"… the biggest problem was for me to get the doctors to actually call for me. They didn’t find a need for me. They knew what I was there to do but they didn’t call for me. The nurses didn’t call for me either so my biggest problem was getting them to send me referrals … they knew that if they had a malnourished patient they needed a dietician to be there … they knew that they needed me for burns patients as well. And um … well if they had overweight outpatient, the doctor just won’t send [for me] but she would tell the patient “Well you need a low fat diet …”

Paterson et al note that the community service dieticians had to make an extra effort to get staff members to utilise their dietetic services. The community service dieticians also felt that they were not part of the team of health staff. They were excluded from various activities and felt frustrated because they were not being appreciated by their fellow health staff.

The issues raised by this research should prompt the Department of Health to examine and implement measures to ensure that the community service experience becomes more valuable to beneficiaries as well as young professional servers. When asked to comment on the research, the national Department of Health said that difficulties encountered by young health professionals in their year of community service should be taken up with the health department in the province in which the service was delivered. This is because the problems experienced in one province are not necessarily experienced in all provinces. The national health department encouraged the young health professionals to take up these difficulties with the department to ensure that the experience of compulsory community service is improved both for communities and for the servers.

Community service has substantial benefits, both for the community being served and the server; however, it can be hampered by various problems if the programme is not effectively managed. The recent research on community service dieticians makes a huge contribution to identifying problems in the programme and paves the way not only for solving the dieticians’ problems but for addressing issues affecting other health professionals doing community service.

[1] Rejoice Shumba is the Project Coordinator at VOSESA.
[2] Paterson, M. (2006). Professional Development of Dieticians Compulsory Community Service in South Africa with Special Focus on KwaZulu-Natal. Pietermaritzburg: Univerity of KwaZulu-Natal.      
[3] Paterson, Green M. and Mounder, E. (2007). Running Before We Walk: How can we maximise the benefits from community service dieticians in KwaZulu-Natal, South Africa?. Health Policy 82 (3). p. 288-301.