Kotha Sudha Rani, Johnson Jennifer C, Galea Sandro, Agyei-Baffour Peter, Nakua Emmanuel, Asabir Kwesi, Kwansah Janet, Gyakobo Mawuli, Dzodzomenyo Mawuli, Kruk Margaret E
University of Michigan Center for Global Health, Ann Arbor, Michigan, USA.
Rural Remote Health. 2012;12:1898. Epub 2012 Sep 6.
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.
卫生工作者短缺和分布不均对卫生系统的能力具有重要影响。加纳是世界上医生移民率最高的国家之一，留在国内的医生中有超过75%在加纳最大的两个城市工作。本研究的目的是调查加纳医学生整个生命周期中的经验因素对其在农村地区执业意愿和移民意愿的影响。
对加纳所有四年级医学生进行了关于人口统计学、农村和国际经历以及未来职业规划的调查。感兴趣的主要结果是学生表示毕业后在贫困农村地区执业或移民的可能性。感兴趣的生命历程预测因素包括父母的社会经济地位、性别、恋爱状况、农村和国际生活经历以及就读学校。使用双变量和多变量逻辑回归来估计预测因素与感兴趣结果之间的关联。
在310名符合条件的学生中，307名（99%）参与了调查。其中，228名是加纳人，是本分析的重点对象。结果发现，131名（57.5%）愿意在加纳贫困地区工作，148名（64.9%）曾考虑毕业后移民。在多变量回归模型中，愿意在贫困地区工作的预测因素包括男性（比值比：2.31，95%置信区间：1.23 - 4.35）、曾在农村地区居住但从未在国外居住（比值比：2.77，95%置信区间：1.08 - 7.13）以及父母的专业和教育地位较低（比值比：2.33，95%置信区间：1.23 - 4.43）。考虑移民的预测因素是曾在国外居住但从未在农村地区居住（比值比：3.39，95%置信区间：1.15 - 9.97）。80名个体（35%）的一个子集报告称，他们愿意在加纳贫困地区工作，但也在考虑移民。这些受试者更可能是男性。
父母社会经济阶层较低、有农村经历且没有国际经历的学生更有可能留在加纳，毕业后也更有可能在贫困地区工作。基于生命历程因素的选择性招生政策，再加上医学院校接触农村实践，可能在增加农村医生数量方面发挥作用。
