rural origin and the retention of professional nurses in rural areas: a five-year follow-up study
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Rural origin and the retention of professional nurses in rural areas: a five-year follow-up study
Duane Blaauw, Prudence Ditlopo, Mylene Lagarde Centre for Health Policy & London School of Hygiene & Tropical Medicine, International Health Economics Conference, Milan, July 2015
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Motivation
Shortage of health workers in rural areas (Dussault & Franceschini, 2007; Serneels et al 2007)
Systematic reviews of successful interventions (Laven, 2003; Wilson et al, 2009; Grobler et al, 2009)
Rural origin strongly associated with rural practice
But evidence mostly for doctors from HIC (Rabinowitz, 1999; Woloschuk, 2002)
Study objective: To evaluate if rural origin is associated with rural retention
in a cohort of professional nurses in South Africa
“Rural setting is a consistent finding in several observational studies. It appears to be the single factor most strongly associated with rural practice” (Cochrane Review, 2009)
Methods South African nursing cohort study
7 nurse training institutions Gauteng and North West provinces
Baseline: Oct 2008
Annual follow-up: 2009-2015 Telephonic questionnaire
Verify contact details Work experience and job movements
Statistical analysis: Stata 12 Duration analysis Logistic regression: predictors of rural retention after 5 years
Participants
377 in total Gauteng (Urban) nursing colleges: 196 North West (Rural) nursing colleges: 110 University: 71
85.7% Female
Average age: 31.0 ± 7.7 years
65.9% Single
46.9% Born in rural area
Total cohort follow-up
0 1 2 3 4 50
100
200
300
400
500
377 373 369 364 365 351
377 373 373 370 368 365
Follow up
TracedInterviewed
Years of follow-up
Num
ber
inte
rvie
wed
Outcomes after 5 years
Total300
310
320
330
340
350
360
370
351
10
37
6
Lost to follow upStopped participationLeft South AfricaDiedInterviewed
Any Job Change
0.00
0.25
0.50
0.75
1.00
% o
f Coh
ort
0 1 2 3 4 5Years of follow-up
TotalKaplan-Meier survival estimate
Any Job Change
0.00
0.25
0.50
0.75
1.00
% o
f Coh
ort
0 1 2 3 4 5Years of follow-up
Urban Province Rural Province
By training locationKaplan-Meier survival estimates
Facility Type
1 2 3 4 50%
20%
40%
60%
80%
100%
57% 52% 49% 45% 45%
43%46% 45%
44% 43%
0% 2% 6% 11% 13%
OtherClinic or CHCHospital
Years of follow-up
% o
f Co
hort
Sector
1 2 3 4 50%
20%
40%
60%
80%
100%
100% 94%85% 80% 77%
6%15% 20% 23%
PrivatePublic
Years of follow-up
% o
f Co
hort
Sector
0.00
0.25
0.50
0.75
1.00
% o
f Coh
ort
0 1 2 3 4 5Years of follow-up
Male Female
By genderKaplan-Meier survival estimates
Area
1 2 3 4 50%
20%
40%
60%
80%
100%
72% 74% 69% 70% 73%
28% 26% 31% 30% 27%
RuralUrban
Years of follow-up
% o
f Co
hort
Job Satisfaction
0 1 2 3 4 5 -
2.0
4.0
6.0
8.0
10.0
6.3 6.77.0 6.9
6.3
Years of Follow-up
Sati
sfac
tion
sco
re
Job Satisfaction
0 1 2 3 4 5 -
2.0
4.0
6.0
8.0
10.0
6.0 6.26.6 6.4 6.3
6.56.8
7.2 7.1 6.8
UrbanRural
Years of Follow-up
Sati
srac
tion
sco
re
Rural Retention after 5 Years
Logistic Regression Odds Ratio 95%CI p value
Over 35 1.739 [0.930; 3.252] 0.083Male 0.721 [0.323; 1.612] 0.426Married 1.008 [0.544; 1.865] 0.981Any children 1.257 [0.518; 3.052] 0.613University 0.899 [0.417; 1.940] 0.787Rural college 9.024
[2.824; 28.837]
< 0.001
Born rural 3.530 [1.871; 6.657]<
0.001Rural exposure 1.437 [0.436; 4.733] 0.551Constant 0.026 [0.008; 0.079] < 0.001
Pseudo R2: 0.305
Conclusions
Relatively high job turnover
Increasing move to the private sector and out of health care facilities
But higher rural retention and job satisfaction than expected
Rural origin and rural training significantly associated with rural retention
Confirm policy implications for student selection and placement of training institutions
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RESYST is funded by UK aid from the UK Department for International Development (DFID). However, the views expressed do not necessarily reflect the Department’s official policies.
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