Labor Attrition between South Africa’s Public and Private Health Sectors: A Mixed-Methods Case Study of KwaZulu-Natal Dietitians

Abstract

The South African health care system has a highly inequitable distribution of human and financial resources. The private sector only serves 28-38% of the population but has 59% of medical specialists. Applying the concept of job satisfaction as a mediator of labor attrition, the study aims included (1) evaluating the factors influencing choice of workplace amongst clinical dietitians, and (2) analyzing the policy implications for improving labor retention. This cross-sectional study employed a mixed-methods design, including job satisfaction surveys (N=66) and semi-structured interviews (N=7). The sample included public and private clinical dietitians in KwaZulu-Natal, South Africa. Data were analyzed using regression modeling and thematic content analysis. The regression analysis revealed private dietitians to be 12.43 points happier than public dietitians on a 12-question job satisfaction survey (95% CI: 6.74, 18.13), after controlling for salary level, degree, job setting, time in current job, university, and specialty. The private sector offers perceived advantages in physical workplace, workday flexibility, and salary level. Government dietitians expressed more favorable professional relationships with dietetic and non-dietetic colleagues, feelings of value, and salary stability. Private dietitians were dissatisfied with income insecurity, colleague competitiveness, and marketing one’s dietetic services. Public dietitians noted poor physical working conditions and limited promotion opportunities. These findings suggest that retention strategies should target public sector staffing shortages, career pathing, and contract flexibility regarding working hours. Further research is needed to evaluate these findings on a national scale and assess the comparative feasibility, favorability, and impact of private contracting models across other allied health professions.