Influences on the choice of health professionals to practice in rural areas.

BACKGROUND: Training health care professionals (HCPs) to work in rural areas is a challenge for educationalists. This study aimed to understand how HCPs choose to work in rural areas and how education influences this. METHODS: Qualitative individual interviews were conducted with 15 HCPs working in rural areas in SA. RESULTS: Themes identified included personal, facilitating, contextual, staying and reinforcing factors. Personal attributes of the HCPs, namely rural origin and/or their value system, determine consideration of rural practice. The decision to 'go rural' is facilitated by exposure to rural practice during training, an understanding of rural needs and exposure to rural role models. Once practising in a rural area, the context and nature of work and the environment influence the decision to remain, supported by the role of family and friends, ongoing training and development, and the style of health service management. Personal motivation is reinforced by a positive relationship with the community, and by being an advocate and role model for the local community. Educational factors were often felt to work against the decision to practise in rural areas. DISCUSSION: The results show the complexity of the interaction between a large number of factors working together to make HCPs choose to go and stay in rural areas. Factors other than educational ones seem more important. A comprehensive approach is needed to attract and retain HCPs in rural areas. Issues for educationalists to address include helping rural-origin students to connect with their own values and communities.

Medical education in the community--the UNITRA experience.

The creation of the independent black state of Transkei, under the apartheid regime, resulted in inadequate allocation of resources to the region. These inequalities were translated into health care. Despite these limitations, over the last five years an innovative community-based educational programme involving medical students, nurses and health educators is evolving at the relatively new medical school in this region. This programme, however, has not been free of difficulties. There is an urgent need to address these issues using a combination of administrative, educational and research approaches. This would provide a strong basis for the further development of this educational programme that could serve as a unique South African example of medical education in the community.