Recruiting and retaining rural students: evidence from a faculty of dentistry in South Africa.

INTRODUCTION There is a shortage internationally of adequately trained health professionals to service rural areas. Health professionals are more likely to practice in communities that are like the one in which they grew up. The WHO therefore suggests targeted university admission policies to facilitate the enrolment of students from rural areas. In South Africa, rural students have special needs with regard to university access and throughput because they come from the most economically disadvantaged communities and often are the first in their families to attend university. This descriptive study, the first in South Africa with a cohort of dentistry students, draws on data from undergraduates at a single faculty of dentistry in South Africa. It investigates the factors affecting rural students' access to university, their academic success, as well as their employment intentions. METHODS A self-administered questionnaire was completed by 304 (70%) of the total number of 435 undergraduate dental students. Closed questions elicited information regarding students' year of study, academic performance, source and adequacy of funding, family history of university attendance, and area of origin. Responses were analyzed using MS Excel and Epi Info™. Qualitative data were used to support quantitative findings. Open-ended questionnaire questions, including employment intentions, and three focus group interviews generated examples to illustrate and elaborate the quantitative findings. RESULTS Only 7% (n=22) of the cohort (n=304) were from rural areas. Rural students relied on assistance from those with university experience to apply and register, for course information and funding opportunities. Most rural students were funded by provincial bursaries (41%; n=9) and National Student Financial Scheme (NSFAS) funding (18%; n=4). Forty-four percent (n=4) of the rural students with provincial bursaries and 100% (n=4) of the rural students with NSFAS funding reported not having enough money for food. All NSFAS-funded rural students (n=4) reported not having enough money to buy the prescribed and recommended texts. Fifty percent (n=2) of the rural students with NSFAS funding had failed at least one academic year. Rural students were least likely to have family members who had attended university. Rural students were three times more likely than other students to want to work in rural areas. CONCLUSION Only a minority of dentistry students came from rural areas, and rural schools did not adequately prepare these students academically for university. Rural students also lacked immediate access to people with insight into the academic and socio-cultural aspects of higher education, including the process of independent learning. Despite financial and academic challenges, rural students had a significantly stronger commitment to rural employment than students from cities and towns. It is recommended that rural students should receive academic, financial, and mentoring support both before and during their studies.