Does financial support for medical students from low income families make a difference? A qualitative evaluation.

BACKGROUND: The 2015-2020 strategic plan from the Office for Fair Access calls on institutions to provide contemporary assessments of the impact of their financial support for disadvantaged students on retention, progression, success, wellbeing and participation, throughout the student lifecycle. In response to this call, this article describes the first evaluation the authors are aware of, of a financial support scheme for students from lower income backgrounds attending a medical school. METHODS: A qualitative study of a bursary scheme for undergraduate medical students was undertaken at a university in London, England. One-to-one, audio-recorded interviews were conducted, transcribed and thematically analysed in order to ascertain eight recipients' experiences of receiving the bursary and its influence on their financial situation, academic studies and quality of life. RESULTS: The data were best explained by five main themes: impact of the bursary, communication, financial management, support preferences, and administration of the bursary. CONCLUSIONS: The participants, who were in receipt of various bursary amounts, generally regarded it as a good scheme with it providing a financial buffer and enabling them to focus on their studies and extracurricular activities rather than seek paid employment during term time.

How Were Return-of-Service Schemes Developed and Implemented in Botswana, Eswatini and Lesotho?

Botswana, Eswatini and Lesotho are three Southern African countries that make use of return-of-service (RoS) schemes to increase human resources for health in their countries. These initiatives bind beneficiaries to a pre-defined period of service upon the completion of their studies based on the length of funding support received. We aimed to review the history of these policies to understand the conceptualisation, intent and implementation of these schemes. We used a multi-methods research design which consisted of a literature review, a policy review and semi-structured interviews with policymakers and implementors. All three governments have a combination of grant-loan schemes and full bursaries or scholarships. The policies have all been operating for over 20 years, with Eswatini's pre-service policy being the oldest since it was introduced in 1977, followed by Lesotho's 1978 policy and Botswana's 1995 pre-service policy. These policies have never been reviewed or updated. RoS schemes in these countries were introduced to address critical skills shortages, to improve employability prospects for citizens, to have competent public sector employees by global standards and to aid the career progress of government employees. Ministries of Health are passive role players. However, these schemes can only be efficient if there is clear cooperation and coordination between all stakeholders.

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. 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.