Rural and Remote Health
Volume 12, Issue 3, 2012

Lifecourse factors and likelihood of rural practice and emigration: A survey of Ghanaian medical students (Article)

Kotha S.R. , Johnson J.C. , Galea S. , Agyei-Baffour P. , Nakua E. , Asabir K. , Kwansah J. , Gyakobo M. , Dzodzomenyo M. , Kruk M.E.
  • a University of Michigan Center for Global Health, Ann Arbor, MI, United States, Global Health, University of Toronto, Toronto, ON, Canada
  • b University of Michigan Center for Global Health, Ann Arbor, MI, United States
  • c Columbia University Mailman School of Public Health, New York City, NY, United States
  • d Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  • e Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  • f Ministry of Health, Accra, Ghana
  • g Ministry of Health, Accra, Ghana
  • h Univeristy of Ghana, Legon, Ghana
  • i Univeristy of Ghana, Legon, Ghana
  • j Columbia University Mailman School of Public Health, New York City, NY, United States

Abstract

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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. © SR Kotha, JC Johnson, S Galea, P Agyei-Baffour, E Nakua, K Asabir, J Kwansah, M Gyakobo, M Dzodzomenyo, ME Kruk, 2012.

Author Keywords

physicians Health manpower Epidemiology Ghana rural

Index Keywords

Medically Underserved Area health care planning psychological aspect methodology demography poverty human statistics health service Marital Status Ghana professional practice Personnel Loyalty Logistic Models Clinical Competence Physicians Urban Health Services family size Family Characteristics Residence Characteristics marriage foreign worker Humans Career Choice male female personnel management Foreign Medical Graduates Multivariate Analysis questionnaire Article manpower Personnel Selection Questionnaires migration physician Professional Practice Location Poverty Areas standard Emigration and Immigration statistical model decision making Students, Medical medical student rural health care Rural Health Services
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84871693058&partnerID=40&md5=8081f70d48c4c0a00018945499edbc4a
ISSN: 14456354
Cited by: 11
Original Language: English