Socio-economic characteristics and career intentions of the WiSDOM health professional cohort in South Africa

Autoři: Laetitia Charmaine Rispel aff001;  Prudence Ditlopo aff002;  Janine Anthea White aff003;  Duane Blaauw aff002
Působiště autorů: Centre for Health Policy & Department of Science and Innovation (DSI) and National Research Foundation (NRF) Research Chair, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Parktown, South Africa aff001;  Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Parktown, South Africa aff002;  School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Parktown, South Africa aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



The human resources for health (HRH) crisis and dearth of research on the health labour market in South Africa informed the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) cohort study. The study aims to generate new knowledge on the career choices and job location decisions of health professionals in South Africa.


WiSDOM is a prospective longitudinal cohort study. During 2017, the first cohort for each of eight professional groups was established: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. These cohorts will be followed up for 15 years. For the baseline data collection, each final year health professional student completed an electronic self-administered questionnaire (SAQ), after providing informed consent. The SAQ included information on: demographic characteristics; financing of training; reasons for choosing their profession; and their career intentions. We used STATA® 14 to analyse the data.


We obtained an 89.5% response rate and 511 final year health professional students completed the baseline survey. The mean age of all participants was 24.1 years; 13.1% were born in a rural area; 11.9% and 8.0% completed their primary and secondary schooling in a rural area respectively. The health professional students came from relatively privileged backgrounds: 45.0% had attended a private school, the majority of their fathers (77.1%) had completed tertiary education, and 69.1% of their mothers had completed tertiary education. Students with higher socio-economic status (SES Quintiles 3–5) made up a larger proportion of the occupational therapists (77.8%), physiotherapists (71.7%), doctors (66.7%), and dentists (64.7%). In contrast, individuals from SES Quintiles 1 and 2 were over-represented among the clinical associates (75.0%), oral hygienists (71.4%), nurses (61.9%), and pharmacists (56.9%). Almost one quarter (24.9%) of cohort members indicated that they had partly financed their studies through loans. Although 86.3% of all cohort members indicated that they plan to stay in their chosen profession, this ranged from 43.2% for clinical associates to 100% for dentists.


WiSDOM has generated new knowledge on health professional graduates of a leading South African University. The results have implications for university selection criteria and national health workforce planning.

Klíčová slova:

Careers – Finance – Graduates – Health care policy – Nurses – Pharmacists – Professions – South Africa


1. WHO. Global strategy on human resources for health: Workforce 2030. Geneva: World Health Organization, 2016.

2. WHO. Draft thirteenth general programme of work, 2019–2023. Report by the Director-General. World Health Assembly Seventy-first World Health Assembly, 71/4, Provisional agenda item 11.1. Geneva: World Health Organization, 2018.

3. High-Level Commission on Health Employment and Economic Growth. Working for health and growth: investing in the health workforce. Report of the High-Level Commission on Health Employment and Economic Growth. Geneva: World Health Organization, 2016.

4. McPake B, Maeda A, Araújo EC, Lemiere C, El Maghraby A, Cometto G. Why do health labour market forces matter? Bull World Health. 2013;91:841–6.

5. Global Health Workforce Alliance, WHO. A universal truth: No health without a workforce. Geneva: World Health Organization; 2013.

6. Van Rensburg HCJ. South Africa’s protracted struggle for equal distribution and equitable access–still not there. Human Resources for Health. 2014;12: 26 doi: 10.1186/1478-4491-12-26 24885691

7. Rispel LC, Padarath A, editors. South African Health Review 2018. Durban: Health Systems Trust; 2018.

8. Munyewende P, Rispel LC. Using diaries to explore the work experiences of primary health care nursing managers in two South African provinces Glob Health Action. 2015;7:25323 -

9. Armstrong SJ, Rispel LC, Penn-Kekana L. The activities of hospital unit managers and quality of patient care in South African hospitals: A paradox? Glob Health Action. 2015;8:26243– doi: 10.3402/gha.v8.26243 25971397

10. The Presidency SA. Twenty year review South Africa, 1994–2014. Pretoria: Government Printing Works; 2014.

11. NDoH. National Health Insurance Policy: Towards universal health coverage. Pretoria, Republic of South Africa: National Department of Health (NDoH), 2017.

12. NDoH. National Health Insurance Bill 2019 Government Gazette. 2019;42598:1–60.

13. Rispel LC, Barron P. Valuing human resources: Key to the success of a national health insurance system. Development Southern Africa. 2012;29(5):616–35. doi: 10.1080/0376835X.2012.730974

14. Daviaud E, Chopra M. How much is not enough? Human resources requirements for primary health care: a case study from South Africa. Bull World Health. 2008;86(1):46–51.

15. Ditlopo P, Blaauw D, Rispel L, Thomas S, Bidwell P. Policy implementation and financial incentives for nurses in two South African provinces: A case study on the occupation specific dispensation Global Health Action. 2013;6(19289 -

16. Heinen MM, van Achterberg T, Schwendimann R, Zander B, Matthews A, Kozka M, et al. Nurses' intention to leave their profession: a cross sectional observational study in 10 European countries. Int J Nurs Stud. 2013;50(2):174–84. doi: 10.1016/j.ijnurstu.2012.09.019 23107005.

17. Rispel LC, Blaauw D, Chirwa T, de Wet K. Factors influencing agency nursing and moonlighting among nurses in South Africa. Glob Health Action. 2014;7(23585):

18. Silvestri DM, Blevins M, Afzal AR, Andrews B, Derbew M, Kaur S, et al. Medical and nursing students’ intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa. Bull World Health Organ. 2014;92. doi: 10.2471/blt.14.136051 25378729

19. Hossain P, Gupta RD, YarZar P, Jalloh MS, Tasnim N, Afrin A, et al. ‘Feminization’of physician workforce in Bangladesh, underlying factors and implications for health system: Insights from a mixed-methods study. PLOS ONE. 2019;14(1):e0210820. doi: 10.1371/journal.pone.0210820 30633775

20. Goel S, Angeli F, Dhirar N, Sangwan G, Thakur K, Ruwaard D. Factors affecting medical students’ interests in working in rural areas in North India—A qualitative inquiry. PLOS ONE 2019;14(1):e0210251. doi: 10.1371/journal.pone.0210251 30629641

21. Caruana EJ, Roman M, Hernández-Sánchez J, Solli P. Longitudinal studies. Journal of Thoracic Disease. 2015;7(11):E537–E40. doi: 10.3978/j.issn.2072-1439.2015.10.63 26716051

22. Driessen J, Settle D, Potenziani D, Tulenko K, Kabocho T, Wadembere I. Understanding and valuing the broader health system benefits of Uganda’s national Human Resources for Health Information System investment. Human Resources for Health. 2015;13:13:49: doi: 10.1186/s12960-015-0036-0 26321475

23. Ishijima H, Mapunda M, Mndeme M, Sukums F, Mlay VS. Challenges and opportunities for effective adoption of HRH information systems in developing countries: national rollout of HRHIS and TIIS in Tanzania. Human Resources for Health. 2015;13:48: doi: 10.1186/s12960-015-0043-1 26077600

24. Riley PL, Zuber A, Vindigni SM, Gupta N, Verani AR, Sunderland NL, et al. Information systems on human resources for health: a global review. Human Resources for Health. 2012;10:7: doi: 10.1186/1478-4491-10-7 22546089

25. Turner C, Bain C, Schluter PJ, Yorkston E, Bogossian F, McClure R, et al. Cohort profile: The nurses and midwives e-cohort study—A novel electronic longitudinal study. International Journal of Epidemiology 2009;38:53–60. doi: 10.1093/ije/dym294 18202083

26. Van Weel C. Longitudinal Research and Data Collection in Primary Care. Annals of Family Medicine. 2005;3(Suppl 1):s46–s51. doi: 10.1370/afm.300 15928218

27. Ployhart RE, Vandenberg RJ. Longitudinal research: The theory, design, and analysis of change. Journal of Management. 2009;36(1):94–120.

28. Liu JX, Goryakin Y, Maeda A, Bruckner T, Scheffler R. Global Health Workforce Labor Market Projections for 2030. Hum Resour Health. 2017;15: 11: doi: 10.1186/s12960-017-0187-2 28159017

29. Belanger CF, Hennekens CH, Rosner B, Speizer FE. The nurses' health study. American Journal of Nursing. 1978;78(6):1039–40. 248266

30. Humphreys JS, McGrail MR, Joyce CM, Scott A, Kalb G. Who should receive recruitment and retention incentives? Improved targeting of rural doctors using medical workforce data. Aust J Rural Health. 2012;20(3–10).

31. Joyce CM, Scott A, Jeon S-H, Humphreys J, Kalb G, Witt J, et al. The ‘Medicine in Australia: Balancing Employment and Life (MABEL)’ longitudinal survey–Protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation. BMC Health Serv Res. 2010;10: 50: doi: 10.1186/1472-6963-10-50 20181288

32. Jinhu Li J, Scott A, McGrail M, Humphreys J, Witt J. Retaining rural doctors: Doctors' preferences for rural medical workforce incentives. Social Science & Medicine. 2014;121:56–64.

33. Li J, Galatsch M, Siegrist J, Mu¨ ller BH, Hasselhorn HM. Reward frustration at work and intention to leave the nursing profession—Prospective results from the European longitudinal NEXT study. International Journal of Nursing Studies. 2011;48:628–35. doi: 10.1016/j.ijnurstu.2010.09.011 20947084

34. Li J, Fu H, Hu Y, Shang L, Wu Y, Kristensen TS, et al. Psychosocial work environment and intention to leave the nursing profession: Results from the longitudinal Chinese NEXT study. Scandinavian Journal of Public Health. 2010;38(3):69–80.

35. Sawaengdee K, Tangcharoensathien V, Theerawit T, Thungjaroenkul P, Thinkhamrop W, Prathumkam P, et al. Thai nurse cohort study: cohort profiles and key findings. BMC Nursing. 2016;15:10: doi: 10.1186/s12912-016-0131-0 26893589

36. Ditlopo P, Blaauw D, Lagarde M. A Longitudinal Study of the Job Choices of a Cohort of South African Nurses to inform Human Resource Policy Interventions: Working Paper #10. Johannesburg: Centre for Health Policy, School of Public Health, University of the Witwatersrand, 2016.

37. University of the Witwatersrand. Vision 2022: Strategic Framework: Wits-knowledge at the leading edge-concept paper. Johannesburg: University of the Witwatersrand, 2010.

38. University of the Witwatersrand. 2017 Annual Report of the University of the Witwatersrand incorporating reports of Senate and Council. Johannesburg: University of the Witwatersrand, 2018.

39. Munro K. Wits Medical School: History, heritage, pioneers and buildings. Wits Review. 2010:33–40.

40. Van der Merwe L, Van Zyl G, Gibson ASC, Viljoen A, Iputo J, Mammen M, et al. South African medical schools: current state of selection criteria and medical students’ demographic profile. South African Medical Journal. 2016;106(1):76–81.

41. WiSDOM. Wits health professional cohort study 2019. Available from:

42. Wits Faculty of Health Sciences. 2019 [cited 2019 9 June ].

43. Harris PA, Taylor R, Thielke R, Payne P, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support,. J Biomed Inform. 2009;42(2):377–81. doi: 10.1016/j.jbi.2008.08.010 18929686

44. Department of Higher Education and Training. Guidelines for the Department of Higher Education and Training Bursary Scheme for Students at Public Universities. Pretoria: Department of Higher Education and Training, 2019.

45. Rudman A, Omne-Pontén M, Wallin L, Gustavsson PJ. Monitoring the newly qualified nurses in Sweden: the Longitudinal Analysis of Nursing Education (LANE) study. Human Resources for Health 2010;8(10):

46. WHO. Delivered by women, led by men: A gender and equity analysis of the global health and social workforce. Geneva: World Health Organization, Human Resources for Health Observer Series No. 24, 2019.

47. Adams T. Gender and feminization in health care professions. Sociology Compass. 2010;4(7):454–65.

48. Kansayisa G, Yi S, Lin Y, Costas-Chavarri A. Gender-based analysis of factors affecting junior medical students' career selection: addressing the shortage of surgical workforce in Rwanda. Human resources for health. 2018;16(1):29–. doi: 10.1186/s12960-018-0295-7 29996860.

49. Mkondo T, Mudzi W, Mbambo NP. Factors influencing Zimbabwean physiotherapy students in choosing physiotherapy as a career. S Afr J Physiotherapy. 2007;63(3):26–31.

50. Khan T, Thomas LS, Naidoo S. Analysing post-apartheid gender and racial transformation in medical education in a South African province. Global Health Action. 2013;6(1):19810.

51. Ng-Sueng LF, Vargas-Matos I, Mayta-Tristán P, Pereyra-Elías R, Montenegro-Idrogo JJ, Inga-Berrospi F, et al. Gender Associated with the Intention to Choose a Medical Specialty in Medical Students: A Cross-Sectional Study in 11 Countries in Latin America. PloS one. 2016;11(8):e0161000-e. doi: 10.1371/journal.pone.0161000 27519055.

52. Mandeville KL, Ulaya G, Lagarde M, Gwesele L, Dzowela T, Hanson K, et al. Early career retention of Malawian medical graduates: a retrospective cohort study. Tropical Medicine & International Health. 2015;20(1):106–14. doi: 10.1111/tmi.12408 PMC4737132. 25329519

53. Yi S, Lin Y, Kansayisa G, Costas-Chavarri A. A qualitative study on perceptions of surgical careers in Rwanda: A gender-based approach. PLOS ONE 2018;13(5):e0197290. doi: 10.1371/journal.pone.0197290 29746556

54. Lescano AG, Cohen CR, Raj T, Rispel L, Garcia PJ, Zunt JR, et al. Strengthening mentoring in low-and middle-income countries to advance global health research: an overview. American Journal of Tropical Medicine and Hygiene. 2019;100(1_Suppl):3–8. doi: 10.4269/ajtmh.18-0556 30430982

55. Erasmus Z. Confronting the categories: Equitable admissions without apartheid race classification. South African Journal of Higher Education. 2010;24(2):244–57.

56. Erasmus Z. Apartheid race categories: daring to question their continued use. Transformation: Critical Perspectives on Southern Africa. 2012;79(1):1–11.

57. Erasmus Z, De Wet J. Not naming race: some medical students' perceptions and experiences of 'race' and racism at the Health Sciences Faculty of the University of Cape Town. Cape Town: University of Cape Town; 2011.

58. Lehmann U, Andrews G, Sanders D. Change and innovation at South African medical schools. An investigation of student demographics, student support and curriculum innovation. South African Health Review. 2000:10–1.

59. Cohen JJ, Gabriel BA, Terrell C. The Case for diversity in the health care workforce. Health Affairs. 2002;21(5):90–102. doi: 10.1377/hlthaff.21.5.90 12224912.

60. Van Rensburg HCJ. Health and health care in South Africa. Pretoria: Van Schaik; 2012.

61. Wu LT, Wang W, Holroyd E, Lopez V, Liaw SY. Factors deterring dentistry, medical, pharmacy, and social science undergraduates from pursuing nursing as a healthcare career: a cross-sectional study in an Asian university. BMC Medical Education. 2018;18(1):23. doi: 10.1186/s12909-018-1118-1 29373973

62. MacGregor RG, Zihindula G, Ross AJ. A rural scholarship model addressing the shortage of healthcare workers in rural areas. In: Rispel L, Padarath A, editors. South African Health Review 2018. 2018. Durban: Health Systems Trust; 2018. p. 51–7.

63. University of the Witwatersrand. Admissions Policy. Johannesburg: University of the Witwatersrand, 2017.

64. University of the Witwatersrand. WITS University revises its MBBCH degree admissions policy. Johannesburg: University of the Witwatersrand, Faculty of Health Sciences, nd.

65. Budhathoki SS, Zwanikken PAC, Pokharel PK, Scherpbier AJ. Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review. BMJ open. 2017;7(2):e013501–e. doi: 10.1136/bmjopen-2016-013501 28232465.

66. Laven G, Wilkinson D. Rural doctors and rural backgrounds: how strong is the evidence? A systematic review. Australian Journal of Rural Health. 2003;11(6):277–84. 14678410

67. MacQueen IT, Maggard-Gibbons M, Capra G, Raaen L, Ulloa JG, Shekelle PG, et al. Recruiting Rural Healthcare Providers Today: a Systematic Review of Training Program Success and Determinants of Geographic Choices. Journal of General Internal Medicine. 2018;33(2):191–9. Epub 2017/11/27. doi: 10.1007/s11606-017-4210-z 29181791.

68. Rural Health Advocacy Project. Rationale for rural proofing the staffing norms Johannesburg: Rural Health Advocacy Project (RHAP), 2013.

69. Rural Health Advocacy Project. Annual Community Service Officer Allocation Update ‘ACUTE’ Johannesburg: Rural Health Advocacy Project (RHAP), 2018.

70. World Bank. Overcoming poverty and inequality in South Africa: An assessment of drivers, opportunities and constraints. Washington D.C.: The World Bank, Retrieved from, 2018.

71. CMoloi K, Makgoba MW, Ogutu Miruka C. (De)constructing the #FeesMustFall Campaign in South African Higher Education. Contemporary Education Dialogue. 2017;14(2):211–23. doi: 10.1177/0973184917716999

72. Nasseh K, Vujicic M. The relationship between education debt and career choices in professional programs: The case of dentistry. The Journal of the American Dental Association. 2017;148(11):825–33. doi: 10.1016/j.adaj.2017.06.042 28843498

73. Phillips JP, Peterson LE, Fang B, Kovar-Gough I, Phillips RL. Debt and the Emerging Physician Workforce: The Relationship Between Educational Debt and Family Medicine Residents’ Practice and Fellowship Intentions. Academic Medicine. 2019;94(2):267–73. doi: 10.1097/ACM.0000000000002468 30256252

74. Puertas EB, Arósquipa C, Gutiérrez D. Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review. Revista Panamericana de Salud Pública. 2013;34:351–8. 24553763

75. Department of Public Service Administration. Salary scales, with translation keys, for employees on salary levels 1 to 12 and those employees covered by Occupation Specific Dispensations (OSDs). Pretoria: DPSA, 2018.

76. Osipow SH. Theories of Career Development. A Comparison of the Theories. New York: Appleton-Century-Crofts; 1968.

77. Goel S, Angeli F, Dhirar N, Singla N, Ruwaard D. What motivates medical students to select medical studies: a systematic literature review. BMC Medical Education. 2018;18(1):16. doi: 10.1186/s12909-018-1123-4 29343262

78. Marcinowicz L, Owlasiuk A, Slusarska B, Zarzycka D, Pawlikowska T. Choice and perception of the nursing profession from the perspective of Polish nursing students: a focus group study. BMC Medical Education. 2016;16(1):243–. doi: 10.1186/s12909-016-0765-3 27644123.

79. Hanna L-A, Askin F, Hall M. First-Year Pharmacy Students’ Views on Their Chosen Professional Career. American Journal of Pharmaceutical Education. 2016;80(9):150. doi: 10.5688/ajpe809150 28090099

80. Avramova N, Yaneva K, Bonev B. First-year dental students’ motivation and attitudes for choosing the dental profession. Acta medica academica. 2014;43(2):113–21. doi: 10.5644/ama2006-124.110 25529516

81. Blaauw D, Ditlopo P, Rispel LC. Nursing education reform in South Africa: lessons from a policy analysis study. Global Health Action. 2014;7:26401 -

82. Traynor M, Galanouli D, Roberts M, Leonard L, Gale T. Identifying applicants suitable to a career in nursing: a value-based approach to undergraduate selection. Journal of Advanced Nursing. 2017;73(6):1443–54. doi: 10.1111/jan.13227 27905663

83. Patterson F, Prescott-Clements L, Zibarras L, Edwards H, Kerrin M, Cousans F. Recruiting for values in healthcare: a preliminary review of the evidence. Advances in Health Sciences Education. 2016;21(4):859–81. doi: 10.1007/s10459-014-9579-4 25616718

84. Couper I, Hugo J. Addressing the shortage of health professionals in South Africa through the development of a new cadre of health worker: the creation of Clinical Associates. Rural & Remote Health. 2014;14(3).

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden