abstract: 'Equity in health outcomes for rural and remote populations in low- and

  middle-income countries (LMICs) is limited by a range of socio-economic,

  cultural and environmental determinants of health. Health professional

  education that is sensitive to local population needs and that attends

  to all elements of the rural pathway is vital to increase the proportion

  of the health workforce that practices in underserved rural and remote

  areas. The Training for Health Equity Network (THEnet) is a

  community-of-practice of 13 health professional education institutions

  with a focus on delivering socially accountable education to produce a

  fit-for-purpose health workforce. The THEnet Graduate Outcome Study is

  an international prospective cohort study with more than 6,000 learners

  from nine health professional schools in seven countries (including four

  LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of

  learners are administered at entry to and exit from medical school, and

  at years 1, 4, 7, and 10 thereafter. The association of learners''

  intention to practice in rural and other underserved areas, and a range

  of individual and institutional level variables at two time points-entry

  to and exit from the medical program, are examined and compared between

  country income settings. These findings are then triangulated with a

  sociocultural exploration of the structural relationships between

  educational and health service delivery ministries in each setting,

  status of postgraduate training for primary care, and current policy

  settings. This analysis confirmed the association of rural background

  with intention to practice in rural areas at both entry and exit.

  Intention to work abroad was greater for learners at entry, with a

  significant shift to an intention to work in-country for learners with

  entry and exit data. Learners at exit were more likely to intend a

  career in generalist disciplines than those at entry however lack of

  health policy and unclear career pathways limits the effectiveness of

  educational strategies in LMICs. This multi-national study of learners

  from medical schools with a social accountability mandate confirms that

  it is possible to produce a health workforce with a strong intent to

  practice in rural areas through attention to all aspects of the rural

  pathway.'
affiliation: 'Larkins, S (Corresponding Author), James Cook Univ, Coll Med \& Dent,
  Anton Breinl Res Ctr Hlth Syst Strengthening, Douglas, Qld, Australia.

  Johnston, Karen; Woolley, Torres; Ketheesan, Sarangan; Larkins, Sarah, James Cook
  Univ, Coll Med \& Dent, Anton Breinl Res Ctr Hlth Syst Strengthening, Douglas, Qld,
  Australia.

  Guingona, Monsie; Cristobal, Fortunato L., Ateneo de Zamboanga Univ, Sch Med, Zamboanga
  City, Philippines.

  Elsanousi, Salwa; Othman, Abu-Bakr, Univ Gezira, Fac Med, Gezira, Sudan.

  Mbokazi, Jabu, Walter Sisulu Univ, Sch Med, Mthatha, South Africa.

  Labarda, Charlie, Univ Philippines, Sch Hlth Sci, Manila, Philippines.

  Upadhyay, Shambhu; Acharya, Balkrishna, Patan Acad Hlth Sci, Patan, Nepal.

  Hogenbirk, John C., Laurentian Univ, Ctr Rural \& Northern Hlth Res, Sudbury, ON,
  Canada.

  Craig, Jonathan C., Flinders Univ S Australia, Coll Med \& Publ Hlth, Adelaide,
  SA, Australia.

  Neusy, Andre-Jacques, Training Hlth Equ Network, New York, NY USA.'
article-number: '582464'
author: Johnston, Karen and Guingona, Monsie and Elsanousi, Salwa and Mbokazi, Jabu
  and Labarda, Charlie and Cristobal, Fortunato L. and Upadhyay, Shambhu and Othman,
  Abu-Bakr and Woolley, Torres and Acharya, Balkrishna and Hogenbirk, John C. and
  Ketheesan, Sarangan and Craig, Jonathan C. and Neusy, Andre-Jacques and Larkins,
  Sarah
author-email: sarah.larkins@jcu.edu.au
author_list:
- family: Johnston
  given: Karen
- family: Guingona
  given: Monsie
- family: Elsanousi
  given: Salwa
- family: Mbokazi
  given: Jabu
- family: Labarda
  given: Charlie
- family: Cristobal
  given: Fortunato L.
- family: Upadhyay
  given: Shambhu
- family: Othman
  given: Abu-Bakr
- family: Woolley
  given: Torres
- family: Acharya
  given: Balkrishna
- family: Hogenbirk
  given: John C.
- family: Ketheesan
  given: Sarangan
- family: Craig
  given: Jonathan C.
- family: Neusy
  given: Andre-Jacques
- family: Larkins
  given: Sarah
da: '2023-09-28'
doi: 10.3389/fpubh.2020.582464
eissn: 2296-2565
files: []
journal: FRONTIERS IN PUBLIC HEALTH
keywords: 'rural practice intention; rural medical practice; barriers and enablers;

  rural practice; human resources for health (HRH); LMIC = low; and

  middle-income countries; practice intentions; social accountability'
keywords-plus: EDUCATION; SYSTEMS; CARE
language: English
month: OCT 19
number-of-cited-references: '30'
orcid-numbers: 'Ketheesan, Sarangan/0000-0002-2323-338X

  Johnston, Karen/0000-0002-0477-4666

  Hogenbirk, John C/0000-0003-0841-4657

  Larkins, Sarah/0000-0002-7561-3202

  Craig, Jonathan/0000-0002-2548-4035'
papis_id: b65bfed1de3ba62dd3891fd75574f311
ref: Johnston2020trainingfitforpurpos
researcherid-numbers: 'Ketheesan, Sarangan/ABB-1898-2021

  Johnston, Karen/ABD-7646-2020

  Hogenbirk, John C/A-7619-2015

  Larkins, Sarah/A-2319-2013

  Craig, Jonathan/E-2813-2013'
times-cited: '4'
title: 'Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income
  Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ
  Between Learners From LMICs and High Income Countries?'
type: Article
unique-id: WOS:000583258000001
usage-count-last-180-days: '0'
usage-count-since-2013: '2'
volume: '8'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2020'