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HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

Executive Summary

Achieving equity in the distribution of health workers between urban and rural areas,is an important priority for the Department of Health. To approach the problem comprehensively, action is needed at every step of a doctors career, starting with the selection of medical students.

Internationally it has been shown that medical students of rural origin are more likely to practice in a rural area after graduation, but this has not been demonstrated in South Africa before. This study aimed to investigate the career choices of medical graduates of rural origin in the South African context, and to determine what proportion of rural origin students are currently practising in a rural area.

This is a retrospective descriptive study. Sample A consisted of a cohort of doctors who graduated in 1991 and 1992. Their home postal addresses at the time of graduation were obtained from the universities, and classified into urban and rural, and their current addresses were obtained from the national medical register. The percentage of rural and urban origin students currently in rural practice was calculated, and a questionnaire was sent to them to determine the reasons for their career choices.

Sample B consisted of the graduates of 1994-1996 from two medical schools. Their addresses at the time of graduation were compared with their current addresses.

Only 14.4% of the graduates of sample A were of rural origin. When comparing addresses, it was found that 38.4% of rural origin graduates are currently practising in rural areas, compared to 12.4% of urban origin graduates (p<0.001).

The questionnaire data showed that 45.9% of the rural origin respondents are in rural practice, compared to 13.3% of the urban origin respondents (p=0.001). In sample B, 41.61% of the rural origin graduates are in rural practice, compared to 5.08% of urban origin graduates (p<0.001).

The findings suggest that the South African situation conforms to the findings in other countries, namely that rural origin medical students are more likely to choose rural careers than urban origin students are. Rural origin graduates are also more likely to choose general practice.