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

article

Karen Johnston¹  Balkrishna Acharya²  John C. Hogenbirk³  Sarangan Ketheesan¹  Jonathan C. Craig⁴  Andre-Jacques Neusy⁵  Sarah Larkins¹  Monsie Guingona⁶  Salwa Elsanousi⁷  Jabu Mbokazi⁸  Charlie Labarda⁹  Fortunato L. Cristobal⁶  Shambhu Upadhyay²  Abu-Bakr Othman⁷  Torres Woolley¹ 

[1] Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University;Patan Academy of Health Sciences;Centre for Rural and Northern Health Research, Laurentian University;College of Medicine and Public Health, Flinders University;Training for Health Equity Network, United States;Ateneo de Zamboanga University School of Medicine;University of Gezira Faculty of Medicine;School of Medicine, Walter Sisulu University;School of Health Sciences, University of the Philippines

关键词: rural practice intention;    rural medical practice;    barriers and enablers;    rural practice;    human resources for health (HRH);    LMIC = low;    and middle-income countries;    practice intentions;    social accountability;   

DOI  :  10.3389/fpubh.2020.582464

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY