This article is part of a series on Towards a scaling-up of training and education for health workers, edited by Hugo Mercer.

Research

Appropriate training and retention of community doctors in rural areas: a case study from Mali

Monique Van Dormael¹ , Sylvie Dugas^1,2 , Yacouba Kone³ , Seydou Coulibaly³ , Mansour Sy³ , Bruno Marchal¹ and Dominique Desplats⁴

¹  Institute of Tropical Medicine, Public Health Department, 155 Nationalestraat, 2000 Antwerp, Belgium

²  Direction Départementale des Affaires Sanitaires et Sociales, 2 boulevard Murat, BP 3840, 53030 Laval cédex 9, France

³  Santé Sud, BPE686, Bamako, Mali

⁴  Santé Sud, 200 Boulevard National, Le Gyptis, Batiment N, 13003 Marseille, France

author email corresponding author email

Human Resources for Health 2008, 6:25doi:10.1186/1478-4491-6-25

Published:	18 November 2008

Abstract

Background

While attraction of doctors to rural settings is increasing in Mali, there is concern for their retention. An orientation course for young practicing rural doctors was set up in 2003 by a professional association and a NGO. The underlying assumption was that rurally relevant training would strengthen doctors' competences and self-confidence, improve job satisfaction, and consequently contribute to retention.

Methods

Programme evaluation distinguished trainees' opinions, competences and behaviour. Data were collected through participant observation, group discussions, satisfaction questionnaires, a monitoring tool of learning progress, and follow up visits. Retention was assessed for all 65 trainees between 2003 and 2007.

Results and discussion

The programme consisted of four classroom modules – clinical skills, community health, practice management and communication skills – and a practicum supervised by an experienced rural doctor. Out of the 65 trained doctors between 2003 and 2007, 55 were still engaged in rural practice end of 2007, suggesting high retention for the Malian context. Participants viewed the training as crucial to face technical and social problems related to rural practice. Discussing professional experience with senior rural doctors contributed to socialisation to novel professional roles. Mechanisms underlying training effects on retention include increased self confidence, self esteem as rural doctor, and sense of belonging to a professional group sharing a common professional identity. Retention can however not be attributed solely to the training intervention, as rural doctors benefit from other incentives and support mechanisms (follow up visits, continuing training, mentoring...) affecting job satisfaction.

Conclusion

Training increasing self confidence and self esteem of rural practitioners may contribute to retention of skilled professionals in rural areas. While reorientations of curricula in training institutions are necessary, other types of professional support are needed. This experience suggests that professional associations dedicated to strengthening quality of care can contribute significantly to rural practitioners' morale.