Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study
Background: South Africa uses government-funded return-of-service (RoS) schemes to train, recruit and retain skilled health professionals in underserved areas. These educate health professionals locally or internationally in return for a commitment to serve in a specified area for an agreed period....
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Healthcare |
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| Online Access: | https://www.mdpi.com/2227-9032/11/21/2821 |
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| author | Sikhumbuzo A. Mabunda Andrea Durbach Wezile W. Chitha Paidamoyo Bodzo Blake Angell Rohina Joshi |
| author_facet | Sikhumbuzo A. Mabunda Andrea Durbach Wezile W. Chitha Paidamoyo Bodzo Blake Angell Rohina Joshi |
| author_sort | Sikhumbuzo A. Mabunda |
| collection | DOAJ |
| description | Background: South Africa uses government-funded return-of-service (RoS) schemes to train, recruit and retain skilled health professionals in underserved areas. These educate health professionals locally or internationally in return for a commitment to serve in a specified area for an agreed period. While such schemes are used widely and are funded by substantial public funds, their exact makeup differs across jurisdictions, and little is known about why these differences have emerged or how they influence their effectiveness or impact on the health system. We aimed to fill these gaps through an analysis of the origins, architecture, and evolution of RoS schemes in South Africa. Methods: A multimethod research study including a policy review, a literature review, and semi-structured interviews of policymakers was undertaken between October 2020 and August 2022. The included policy documents and literature were analysed using the Walt and Gilson framework and narrative synthesis. Qualitative data were analysed using inductive, thematic analysis in NVIVO 12. Results: RoS schemes are used as a recruitment and retention strategy and a mechanism to address equity in access to medical education. Whilst there is evidence of RoS schemes existing in 1950, no evidence of beneficiaries was found in databases until 1989. The impact of these schemes is likely being limited by sub-optimal institutional arrangements and poor transparency in their design and implementation. Conclusion: Despite rigorous research methods, the origins of RoS policies in South Africa could not be established due to poor preservation of institutional memory. Opportunities to monitor the value of public investment into RoS programs are being missed and often the underlying objective of the programs has not been well-specified. Policies were found to have been developed and operate in isolation from other health workforce planning activities and thus may not be maximising their impact as a retention and training tool. |
| first_indexed | 2024-03-11T11:29:20Z |
| format | Article |
| id | doaj.art-0b835b30f3ae4305b375e49f16ec0b37 |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-11T11:29:20Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-0b835b30f3ae4305b375e49f16ec0b372023-11-10T15:03:41ZengMDPI AGHealthcare2227-90322023-10-011121282110.3390/healthcare11212821Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods StudySikhumbuzo A. Mabunda0Andrea Durbach1Wezile W. Chitha2Paidamoyo Bodzo3Blake Angell4Rohina Joshi5School of Population Health, University of New South Wales, Sydney, NSW 2052, AustraliaAustralian Human Rights Institute, University of New South Wales, Sydney, NSW 2052, AustraliaHealth Systems Enablement and Innovation Unit, University of the Witwatersrand, Johannesburg 2000, South AfricaHealth Systems Enablement and Innovation Unit, University of the Witwatersrand, Johannesburg 2000, South AfricaThe George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, AustraliaSchool of Population Health, University of New South Wales, Sydney, NSW 2052, AustraliaBackground: South Africa uses government-funded return-of-service (RoS) schemes to train, recruit and retain skilled health professionals in underserved areas. These educate health professionals locally or internationally in return for a commitment to serve in a specified area for an agreed period. While such schemes are used widely and are funded by substantial public funds, their exact makeup differs across jurisdictions, and little is known about why these differences have emerged or how they influence their effectiveness or impact on the health system. We aimed to fill these gaps through an analysis of the origins, architecture, and evolution of RoS schemes in South Africa. Methods: A multimethod research study including a policy review, a literature review, and semi-structured interviews of policymakers was undertaken between October 2020 and August 2022. The included policy documents and literature were analysed using the Walt and Gilson framework and narrative synthesis. Qualitative data were analysed using inductive, thematic analysis in NVIVO 12. Results: RoS schemes are used as a recruitment and retention strategy and a mechanism to address equity in access to medical education. Whilst there is evidence of RoS schemes existing in 1950, no evidence of beneficiaries was found in databases until 1989. The impact of these schemes is likely being limited by sub-optimal institutional arrangements and poor transparency in their design and implementation. Conclusion: Despite rigorous research methods, the origins of RoS policies in South Africa could not be established due to poor preservation of institutional memory. Opportunities to monitor the value of public investment into RoS programs are being missed and often the underlying objective of the programs has not been well-specified. Policies were found to have been developed and operate in isolation from other health workforce planning activities and thus may not be maximising their impact as a retention and training tool.https://www.mdpi.com/2227-9032/11/21/2821health systemhealth workforcehuman resourceshealth policybursaryreturn of service or RoS |
| spellingShingle | Sikhumbuzo A. Mabunda Andrea Durbach Wezile W. Chitha Paidamoyo Bodzo Blake Angell Rohina Joshi Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study Healthcare health system health workforce human resources health policy bursary return of service or RoS |
| title | Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study |
| title_full | Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study |
| title_fullStr | Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study |
| title_full_unstemmed | Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study |
| title_short | Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study |
| title_sort | development objectives and operation of return of service bursary schemes as an investment to build health workforce capacity in south africa a multi methods study |
| topic | health system health workforce human resources health policy bursary return of service or RoS |
| url | https://www.mdpi.com/2227-9032/11/21/2821 |
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