Abstract
Health worker shortages and maldistribution have important implications for the capacity of health systems. Ghana has one of the highest physician emigration rates in the world, and over 75% of those who remain work in Ghana's two largest cities. The aim of this study was to investigate the contribution of experiential factors across Ghanaian medical students' lifespans on intent to practice in a rural area and intent to emigrate. All fourth year medical students in Ghana were surveyed on demographics, rural and international experience, and future career plans. Key outcomes of interest were students' stated likelihood of practicing in a deprived rural area or emigrating after graduation. Lifecourse predictors of interest were parental socioeconomic status, gender, relationship status, rural and international living experience, and school of study. Bivariate and multivariate logistic regression were used to estimate associations between predictors and outcomes of interest. Of 310 eligible students, 307 (99%) participated in the survey. Of these, 228 were Ghanaian and the focus of this analysis. It was found that 131 (57.5%) were willing to work in a deprived area in Ghana and 148 (64.9%) had considered emigrating after graduation. In the multivariate regression models, willingness to work in a deprived area was predicted by male gender (OR: 2.31, 95%CI: 1.23-4.35), having lived in a rural area but never lived abroad (OR: 2.77, 95%CI: 1.08-7.13), and low parental professional and educational status (OR: 2.33, 95%CI: 1.23-4.43). Consideration of emigration was predicted by having lived abroad but never in a rural area (OR: 3.39, 95%CI: 1.15-9.97). A sub-set of 80 individuals (35%) reported that they were willing to work in a deprived area in Ghana but also considering emigration. These subjects were more likely to be male. Students with parents of a lower socioeconomic class, those with rural experience, and those without international experience are more likely to stay in Ghana and are also more likely to work in a deprived area after graduation. Selective admissions policies based on lifecourse factors combined with exposure to rural practice in medical school may have a role in increasing the number of rural physicians.
Highlights
Health worker shortages and maldistribution have important implications for the capacity of health systems
The current study examined how lifetime exposure to rural areas, international travel and parental circumstances affect willingness to work in a rural/deprived area and consideration of emigration
Two-thirds of students were male (67.8%) and few students were born in a rural area (12.4%)
Summary
Health worker shortages and maldistribution have important implications for the capacity of health systems. The aim of this study was to investigate the contribution of experiential factors across Ghanaian medical students’ lifespans on intent to practice in a rural area and intent to emigrate. Key outcomes of interest were students’ stated likelihood of practicing in a deprived rural area or emigrating after graduation. The mobilization and strengthening of human resources for health is central to building sustainable health systems. This will assist in meeting the UN’s health Millennium Development Goals (MDGs) and improving health outcomes[1]. Many low and middle income countries suffer from severe health staff shortages and/or maldistribution which weakens the health system. Low and middle income countries face the challenges of producing adequate numbers of heath workers, retaining those workers in the country after graduation, and distributing them rationally within country
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