Contribution of a bonded scholarship scheme to staffing rural health facilities


  • R G MacGregor Umthombo Youth Development Foundation, Hillcrest, Durban, South Africa
  • A J Ross Discipline of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa



Human resouce management, Health education


Background. Local and international research has identified rural origin as an important reason why healthcare professionals (HCPs) work in rural areas, and in South Africa (SA) considerable effort has gone into recruiting and training rural-origin students. However, there is little information in the SA literature on where graduates supported by these initiatives work, and whether they contribute to the rural workforce long term.

Objective. To determine the number of years that rural-origin Umthombo Youth Development Foundation (UYDF)-supported graduates of different disciplines worked at rural public healthcare facilities (PHCFs).
Methods. A retrospective descriptive study reviewed work record data of 405 UYDF graduates, to calculate the number of years they worked at a rural PHCF. Data were analysed descriptively and presented in tables with totals and percentages.

Results. Ninety percent (363/405) of UYDF-supported graduates returned to work at a rural PHCF. High percentages of social workers (85%), optometrists (80%), speech therapists, nurses (72%) and dental therapists (70%) worked for ≥5 years at a rural PHCF, while only 13% of audiologists, 14% of doctors, 29% of pharmacists, and 28% of dentists and occupational therapists worked at a rural PHCF for ≥5 years. Ten percent (42/405) of graduates did not work at a rural PHCF at all. A total of 110/124 (89%) of doctors supported by UYDF had worked at a rural PHCF, with 32% (40/124) working at a rural PHCF for ≥3 years. Overall, 54% of UYDF-supported graduates (219/405) worked for ≥3 years at a rural PHCF, and 38.5% (157/405) worked for ≥5 years at rural PHCFs. The majority of UYDF graduates had contributed towards long-term staffing of rural PHCFs. Lack of professional development opportunities at rural PHCFs as well as the reduced number of funded posts at rural PHCFs reduced the effectiveness of the UYDF initiative.

Conclusion. The UYDF Scholarship Scheme has shown that investment in rural students through a bonded scholarship can contribute to staffing rural PHCFs, as >90% of graduates worked at rural PHCFs, and for some disciplines >70% of graduates worked for ≥5 years at a rural PHCF. Allied HCPs worked on average for longer periods at rural PHCFs than doctors.

Author Biography

  • R G MacGregor, Umthombo Youth Development Foundation, Hillcrest, Durban, South Africa


    Umthombo Youth Development Foundation 


Human Resources for Health South Africa: HRH Strategy for the Health Sector 2012/13 - 2016/17. Pretoria: National Department of Health, South Africa, 2011.

World Health Organization. A universal truth: No health without a workforce. Geneva: WHO, 2013. 3. National Department of Health, South Africa. 2030 human resources for health strategy: Investing in

the health workforce for universal health coverage. Pretoria: NDoH, 2020.

Wilson NW, Couper ID, de Vries E, Reid S, Fish T, Marais BJ. A critical review of interventions to

redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote

Health 2009;9(2):1060-1082.

Ross A, MacGregor G, Campbell L. Review of the Umthombo Youth Development Foundation

scholarship scheme, 1999 - 2013. Afr J Primary Healthcare Fam Med 2015;7(1):1-6.

George A, Blaauw D, Thompson J, Green-Thompson L. Doctor retention and distribution in post- apartheid South Africa: Tracking medical graduates (2007 - 2011) from one university. Hum Resource

Health 2019;17(100):1-9.

Russell D, Mathew S, Fitts M, et al. Interventions for health workforce retention in rural and remote

areas: A systematic review. Hum Resource Health 2021;19(1): 1- 24.


Ross A. Working in rural areas – the experiences of Umthombo Youth Development Foundation graduates. Afr J Primary Healthcare Fam Med 2014;6(1):e1-e7.

Purohit B, Bandyopadhyay T. Beyond job security and money: Driving factors of motivation for government doctors in India. Hum Resource Health 2014;12(12):1-13.

Afriyie DO, Nyoni J, Ahmat A. The state of strategic plans for the health workforce in Africa. BMJ Glob Health 2019;4(Suppl 9):1- 5.

MacGregor RG, Ross A. The effects of various retention factors on the choice of where rural origin Umthombo Youth Development Foundation health science graduates work. Rural and Remote Health 2024;24:1-11.

KwaZulu-Natal Bursaries. KZN Department of Health, 2022. htm (accessed 24 January 2023).

Sui X, Reddy P, Nyembezi A, et al. Cuban medical training for South African students: A mixed methods study. BMC Med Educ 2019;19(1):1- 11.

Slottow R. University of KwaZulu-Natal College of Health Sciences Guideline Document for Selection for the First Year Intake of 2016. University of KwaZulu-Natal, 2015.

Mapukata NO, Couper I, Smith J. The value of the WIRHE Scholarship Programme in training health professionals for rural areas: Views of participants. Afr J Prim Health Care Fam Med 2017;9(1):1-6.

MacGregor RG, Ross AJ, Zihindula G. A rural scholarship model addressing the shortages of healthcare workers in rural areas. South African Health Review, Health Systems Trust. Durban Health Systems Trust; 2018:49-55.

Motala MJVW. Where are they working? A case study of twenty Cuban-trained South African doctors. Afr J Prim Health Care Fam Med 2019;21(11):1- 9.

Smith J. Human resources for rural health – project evaluation. Pretoria: Swiss-South African Co-operative Initiative (SSACI), 2012.

KwaZulu-Natal Budget Policy Statement 2022/23. Pietermaritzburg, 2022. za/Downloads/budget-speech-10052022.pdf (accessed 22 July 2022).

Apply for financial assistance from NSFAS. Pretoria, 2021. education/apply-financial-assistance-national-student-financial-aid-scheme-nsfas# (accessed 12 March 2021).

National Treasury. Delivering municipal services in rural areas. Chapter 12. Pretoria: National Treasury, 2011. lgber%20-%20final%20-%209%20sept%202011.pdf (accessed 12 March 2021).

De Vries E, Reid SJ. Do South African medical students of rural origin return to rural practice? S Afr Med J 2003;10(93):789-793.

KwaZulu-Natal Department of Health. Circular no G01/2022 – cost containment plan for 2021/22. Pietermaritzburg: KZN DoH, 2022 (accessed 14 July 2022).

Gumede DM, Taylor M, Kvalsvig J. Engaging future healthcare professionals for rural health services in South Africa: Students’, graduates’ and managers’ perceptions. BMC Health Serv Res 2021;21(1):1-15.

Reid S. 20 years of community service in South Africa: What have we learnt? Durban: Health Systems Trust, 2018:41-50.







How to Cite

MacGregor RG, Ross AJ. Contribution of a bonded scholarship scheme to staffing rural health facilities. S Afr Med J [Internet]. 2024 Mar. 18 [cited 2024 Apr. 21];114(3):e1608. Available from:

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