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

Sikhumbuzo A Mabunda; Andrea Durbach; Wezile W Chitha; Paidamoyo Bodzo; Blake Angell; Rohina Joshi

doi:10.3390/healthcare11212821

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 (Basel). 2023 Oct 25;11(21):2821. doi: 10.3390/healthcare11212821.

Authors

Sikhumbuzo A Mabunda^{1

2}, Andrea Durbach³, Wezile W Chitha⁴, Paidamoyo Bodzo⁴, Blake Angell², Rohina Joshi^{1

2

5}

Affiliations

¹ School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia.
² The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia.
³ Australian Human Rights Institute, University of New South Wales, Sydney, NSW 2052, Australia.
⁴ Health Systems Enablement and Innovation Unit, University of the Witwatersrand, Johannesburg 2000, South Africa.
⁵ The George Institute for Global Health India, New Delhi 110025, India.

Abstract

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.

Keywords: bursary; health policy; health system; health workforce; human resources; return of service or RoS.

Publication types

Review

Abstract

Publication types

Grants and funding