Educational Factors That Influence the Urban-Rural Distribution of Health Professionals in South Africa: A Case-Control Study (Original Articles) (Report‪)‬

Among factors that influence health professionals' career choices in favour of rural and under-served communities, the role of undergraduate and postgraduate training is assumed to be significant. (1-3) Selection criteria for entry to training, timing, duration, site and type of exposure to educational opportunities in rural and underserved areas during the undergraduate phase, and the availability of postgraduate programmes that support rural practitioners, all influence the decisions of health science graduates regarding their site of practice. (4) However, the extent of this influence has not been assessed in resource-constrained settings, and the applicability of international studies in South Africa has been questioned. While a correlation between medical students' rural origin and practice in rural areas after qualification has been established, (5-11) the evidence for the influence of exposure to community-based and rural placements during undergraduate training is less conclusive. Most medical schools in South Africa have carried out major revisions of undergraduate medical curricula, some towards a 5-year degree. Four universities identified the need for attention to rural health, and appointed senior academics to pilot new programmes in this area at undergraduate and postgraduate levels. Three universities have established specific rural sites for training health science students in this field. A study of innovative curricula and student support programmes at South African medical schools in 2000 found that all schools had introduced selection criteria and academic support mechanisms to facilitate access for historically disadvantaged students. (12) Two schools included in this study had also deliberately moved away from hospital-based towards community-based education.