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Risk 4: The pool of existing practising clinical specialists will be diminished by the promotion of 52 specialists of each category on the DCST to HOCU posts
Appointment of specialists to HOCU posts will result in the loss of 52 specialists rendering patient care in each specialty proposed on the DCST.
Their scope of practice is ideally suited to the majority of the current functions of a HOCU on a DCST, since it includes, but is not limited to, demography, epidemiology, biostatistics, health systems management, public administration, social sciences, communicable and non-communicable disease control, disease outbreak management and co-ordination, and environmental and occupational medicine.
In assessing the DCST strategy with specific reference to HOCUs, numerous risks were identified.
Risk 1: Failure to retain HOCUs in DCSTs may bring about human resource and financial imbalances in the public health system
Despite HOCUs being successfully recruited in some districts, doubts have been expressed about the length of their retention.
Risk 2: HOCUs will ultimately perform their commuted overtime duties in district facilities if the regional or tertiary hospital is too far away from their district-based location
PHC costs will increase since all HOCUs (except FPs) will require the support of a medical officer while performing commuted overtime, to deal with generalist cases that fall outside the specialist's scope of practice.
According to the Commuted Overtime Policy in Gauteng,  HOCUs are restricted to 12 hours of commuted overtime per week; in exceptional cases, 16-20 hours may be granted.
Risk 3: HOCUs (the FP excepted) will be restricted in their scope of practice, especially in rural districts, resulting in skills loss
A retention strategy for HOCUs, especially in rural districts, needs to be developed urgently.
In future, instead of appointing HOCUs at the district level, FPs, entry level specialists or medical officers with specialist diplomas (diplomates) should be appointed within district hospitals.
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