Medical and nursing students' intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa

To assess medical and nursing students' intentions to migrate abroad or practice in rural areas. We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Za...

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Bibliographic Details
Published in:	Bulletin of the World Health Organization 2014-10, Vol.92 (10), p.750-759
Main Authors:	Silvestri, David M, Blevins, Meridith, Afzal, Arfan R, Andrews, Ben, Derbew, Miliard, Kaur, Simran, Mipando, Mwapatsa, Mkony, Charles A, Mwachaka, Philip M, Ranjit, Nirju, Vermund, Sten
Format:	Article
Language:	eng ; por
Subjects:	Adult Africa Africa South of the Sahara Asia Asia, Southeastern Bangladesh Career Choice Careers Cross sections Cross-sectional analysis Education reform Emigration Emigration and Immigration Ethiopia Female Health Policy & Services High income Humans India Industrialized nations Institutions Intention Kenya Language policy Malawi Male Medical Medical personnel Midwifery Migration Nepal Nurses Nursing Profession Professionals Rural Rural areas Rural Health Services - manpower Schools Shortages Students Students, Medical - psychology Students, Nursing - psychology Studies Surveys and Questionnaires Tanzania Zambia
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Summary:	To assess medical and nursing students' intentions to migrate abroad or practice in rural areas. We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students' intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models. Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25-2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21-6.29) and rural (OR: 4.84; 95% CI: 3.52-6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19-1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50-0.96). A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.
ISSN:	0042-9686 1564-0604