Training a fit-for-purpose rural health workforce for low- and middle-income countries (LMICs): how do drivers and enablers of rural practice intention differ between learners from LMICs and high income countries?

Johnston, Karen, Guingona, Monsie, Elsanousi, Salwa, Mbokazi, Jabu, Labarda, Charlie, Cristobal, Fortunato L., Upadhyay, Shambhu, Othman, Abu-Bakr, Woolley, Torres, Acharya, Balkrishna, Hogenbirk, John C., Ketheesan, Sarangan, Craig, Jonathan C., Neusy, Andre-Jacques, and Larkins, Sarah (2020) Training a fit-for-purpose rural health workforce for low- and middle-income countries (LMICs): how do drivers and enablers of rural practice intention differ between learners from LMICs and high income countries? Frontiers in Public Health, 8. 582464.

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Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points—entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.

Item ID: 65986
Item Type: Article (Research - C1)
ISSN: 2296-2565
Keywords: Rural practice intention; Rural medical practice; Barriers and enablers; Rural practice; Human resources for health (HRH); LMIC = low- and middle-incomce countries; Practice intentions; Social accountability
Copyright Information: Copyright © 2020 Johnston, Guingona, Elsanousi, Mbokazi, Labarda, Cristobal, Upadhyay, Othman, Woolley, Acharya, Hogenbirk, Ketheesan, Craig, Neusy and Larkins. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s)are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Funders: Atlantic Philanthropies (AP), Arcadia Foundation (AF), Ministry of Health and Long-Term Care, Ontario, Canada (MHLTC)
Date Deposited: 11 Feb 2021 04:44
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420399 Health services and systems not elsewhere classified @ 50%
39 EDUCATION > 3903 Education systems > 390305 Professional education and training @ 50%
SEO Codes: 20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200508 Rural and remote area health @ 50%
16 EDUCATION AND TRAINING > 1699 Other education and training > 169999 Other education and training not elsewhere classified @ 50%
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