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http://resyst.lshtm.ac.uk
@RESYSTresearch
Rural origin and the retention of
professional nurses in rural areas:
a five-yea...
Motivation
 Shortage of health workers in rural areas (Dussault &
Franceschini, 2007; Serneels et al 2007)
 Systematic r...
Methods
 South African nursing cohort study
 7 nurse training institutions
 Gauteng and North West provinces
 Baseline...
Participants
 377 in total
 Gauteng (Urban) nursing colleges: 196
 North West (Rural) nursing colleges: 110
 Universit...
Total cohort follow-up
377 373 373 370 368 365
377 373 369 364 365
351
0
100
200
300
400
500
0 1 2 3 4 5
Numberinterviewed...
Outcomes after 5 years
351
10
3
7
6
300
310
320
330
340
350
360
370
Total
Lost to follow up
Stopped participation
Left Sou...
Any Job Change
0.00
0.25
0.50
0.75
1.00
%ofCohort
0 1 2 3 4 5
Years of follow-up
Total
Kaplan-Meier survival estimate
Any Job Change
0.00
0.25
0.50
0.75
1.00
%ofCohort
0 1 2 3 4 5
Years of follow-up
Urban Province Rural Province
By training...
Facility Type
57%
52% 49% 45% 45%
43%
46%
45%
44% 43%
0% 2% 6%
11% 13%
0%
20%
40%
60%
80%
100%
1 2 3 4 5
%ofCohort
Years o...
Sector
100%
94%
85%
80% 77%
6%
15%
20% 23%
0%
20%
40%
60%
80%
100%
1 2 3 4 5
%ofCohort
Years of follow-up
Private
Public
Sector
0.00
0.25
0.50
0.75
1.00
%ofCohort
0 1 2 3 4 5
Years of follow-up
Male Female
By gender
Kaplan-Meier survival estim...
Area
72% 74%
69% 70% 73%
28% 26%
31% 30% 27%
0%
20%
40%
60%
80%
100%
1 2 3 4 5
%ofCohort
Years of follow-up
Rural
Urban
Job Satisfaction
6.3
6.7
7.0 6.9
6.3
-
2.0
4.0
6.0
8.0
10.0
0 1 2 3 4 5
Satisfactionscore
Years of Follow-up
Job Satisfaction
6.5
6.8
7.2 7.1
6.8
6.0 6.2
6.6 6.4 6.3
-
2.0
4.0
6.0
8.0
10.0
0 1 2 3 4 5
Satisractionscore
Years of Fol...
Rural Retention after 5 Years
Logistic Regression Odds Ratio 95%CI p value
Over 35 1.739 [0.930; 3.252] 0.083
Male 0.721 [...
Conclusions
 Relatively high job turnover
 Increasing move to the private sector and out of
health care facilities
 But...
http://resyst.lshtm.ac.uk
@RESYSTresearch
RESYST is funded by UK aid from the
UK Department for International
Development ...
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Rural origin and the retention of professional nurses in rural areas: a five-year follow-up study

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This presentation was given at the International Health Economics Association (iHEA) World Congress in Milan, in July 2015.

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Rural origin and the retention of professional nurses in rural areas: a five-year follow-up study

  1. 1. http://resyst.lshtm.ac.uk @RESYSTresearch 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 http://resyst.lshtm.ac.uk @RESYSTresearch
  2. 2. 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)
  3. 3. 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
  4. 4. 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
  5. 5. Total cohort follow-up 377 373 373 370 368 365 377 373 369 364 365 351 0 100 200 300 400 500 0 1 2 3 4 5 Numberinterviewed Years of follow-up Follow up Traced Interviewed
  6. 6. Outcomes after 5 years 351 10 3 7 6 300 310 320 330 340 350 360 370 Total Lost to follow up Stopped participation Left South Africa Died Interviewed
  7. 7. Any Job Change 0.00 0.25 0.50 0.75 1.00 %ofCohort 0 1 2 3 4 5 Years of follow-up Total Kaplan-Meier survival estimate
  8. 8. Any Job Change 0.00 0.25 0.50 0.75 1.00 %ofCohort 0 1 2 3 4 5 Years of follow-up Urban Province Rural Province By training location Kaplan-Meier survival estimates
  9. 9. Facility Type 57% 52% 49% 45% 45% 43% 46% 45% 44% 43% 0% 2% 6% 11% 13% 0% 20% 40% 60% 80% 100% 1 2 3 4 5 %ofCohort Years of follow-up Other Clinic or CHC Hospital
  10. 10. Sector 100% 94% 85% 80% 77% 6% 15% 20% 23% 0% 20% 40% 60% 80% 100% 1 2 3 4 5 %ofCohort Years of follow-up Private Public
  11. 11. Sector 0.00 0.25 0.50 0.75 1.00 %ofCohort 0 1 2 3 4 5 Years of follow-up Male Female By gender Kaplan-Meier survival estimates
  12. 12. Area 72% 74% 69% 70% 73% 28% 26% 31% 30% 27% 0% 20% 40% 60% 80% 100% 1 2 3 4 5 %ofCohort Years of follow-up Rural Urban
  13. 13. Job Satisfaction 6.3 6.7 7.0 6.9 6.3 - 2.0 4.0 6.0 8.0 10.0 0 1 2 3 4 5 Satisfactionscore Years of Follow-up
  14. 14. Job Satisfaction 6.5 6.8 7.2 7.1 6.8 6.0 6.2 6.6 6.4 6.3 - 2.0 4.0 6.0 8.0 10.0 0 1 2 3 4 5 Satisractionscore Years of Follow-up Urban Rural
  15. 15. Rural Retention after 5 Years Logistic Regression Odds Ratio 95%CI p value Over 35 1.739 [0.930; 3.252] 0.083 Male 0.721 [0.323; 1.612] 0.426 Married 1.008 [0.544; 1.865] 0.981 Any children 1.257 [0.518; 3.052] 0.613 University 0.899 [0.417; 1.940] 0.787 Rural college 9.024 [2.824; 28.837] < 0.001 Born rural 3.530 [1.871; 6.657] < 0.001 Rural exposure 1.437 [0.436; 4.733] 0.551 Constant 0.026 [0.008; 0.079] < 0.001 Pseudo R2: 0.305
  16. 16. 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
  17. 17. http://resyst.lshtm.ac.uk @RESYSTresearch 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. http://resyst.lshtm.ac.uk @RESYSTresearch

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