Maldistribution of the medical workforce in Tanzania: predictors of willingness for rural medical practice among Tanzanian final year medical students

Abstract

Human resources for health in Tanzania are in short supply and urban-biased. Preference for urban practice prevails among newly graduating medical doctors. This study sought to determine the factors influencing willingness for rural practice among Tanzanian final year medical students. A cross sectional survey was conducted among 130 medical students at MUCHS and HKMU in Dar es Salaam and KCMC in Moshi. Structured questionnaire was used to collect data on demographic characteristics, rural experience, perception of rural facilities, employment prospects, willingness to accept rural posts, and perceived advantages and disadvantages of rural career. About 35% of students would specifically consider a rural post in their job search, while 59.4% would accept to be posted to rural areas by their employers although they would not initially apply for it. Students from a rural background were twice more likely to be willing for rural practice compared to their urban counterparts (p=0.004). The influence of gender, age and source of sponsorship on willingness for rural practice was not statistically significant. Willingness for rural practice was also influenced by type of rural experience, perceived state of rural health facilities, intended fields of specialization, and perceived merits and demerits of a rural career. t

Vlll The Government and other employers should recruit doctors centrally through their headquarters and deploy them equitably in the peripheral under served districts. An affirmative action is needed to increase representation of rural background students in medical schools. Medical school curricula and internship programs should incorporate Rural Medical Practice as an essential component. Remuneration and incentive packages for doctors in Tanzania need to be improved.