|ORIGINAL RESEARCH PAPER
|Year : 2008 | Volume
| Issue : 3 | Page : 164
Profile and Career Preferences of Pharmacy Students at the University of Limpopo, Turfloop Campus, South Africa
SI Modipa, YM Dambisya
University of Limpopo, Polokwane, South Africa
|Date of Submission||16-Jan-2008|
|Date of Acceptance||07-Nov-2008|
|Date of Web Publication||19-Dec-2008|
S I Modipa
University of Limpopo, Polokwane
Source of Support: None, Conflict of Interest: None
Context: There is a maldistribution of pharmacists in the South African health system, with only 15.6% of pharmacists working in the public sector, while the public sector serves more than 80% of the population.
Setting: University of Limpopo, Turfloop Campus, Pharmacy Programme.
Objective: To establish the profile and career preferences of University of Limpopo pharmacy students and investigate factors likely to influence their choices.
Design: Cross-sectional descriptive study of Bachelor of Pharmacy students, using a semi-structured questionnaire.
Findings: The response rate was 93% (157/169), with 44% female and 69% between the ages of 21 to 25 years. Nearly 80% of respondents were of rural origin; 77% attended rural government schools, 18% urban government schools, and 4% attended private schools. Only 39% of students indicated pharmacy as their first choice and 47% as second choice. Forty-six percent of the responding students preferred to work in a government hospital, 36% in industry, and 7%, 6% and 3% in private hospitals, the retail sector and academia, respectively. About 40% indicated a preference to work in rural areas. Most of the students stated service to community and paying back their sponsor as their main reasons for government hospital preference. Money, in combination with other reasons (e.g., working conditions), influenced work sector preference for less than 15% of responding students - with non-monetary incentives apparently more influential in student public sector preferences.
Conclusions: Most University of Limpopo pharmacy students intend to work in rural areas and the public sector, and are mainly motivated by the need to serve the community.
Keywords: Human resources, health shortages, rural health services, career choices, pharmacy education, public sector, community service
|How to cite this article:|
Modipa S I, Dambisya Y M. Profile and Career Preferences of Pharmacy Students at the University of Limpopo, Turfloop Campus, South Africa. Educ Health 2008;21:164
Sub-Saharan Africa is faced with a human resources for health (HRH) challenge, characterized by low HRH to population ratios, inadequate numbers, misdistribution of available workers, emigration, low salaries, unsafe work environments and poor HRH management and planning at the country level (Padarath et al., 2003; Awases et al., 2004, World Health Organization, WHO, 2006). Internal migration also occurs within countries from public to private sectors and from rural to urban areas, mostly due to better salaries and working conditions in urban areas and lack of infrastructure and other facilities in rural areas (Awases et al., 2004; Vujicic et al., 2004; Dambisya, 2007).
There are inequalities in the distribution of skilled health workers in South Africa, with a shortage of most categories of health professionals in the public sector relative to the private sector (Dambisya, 2005). Only 16% of registered pharmacists work in the public sector (Health Systems Trust, 2008); moreover, two rich provinces, Gauteng and Western Cape, have 56% of the country’s pharmacists, while serving only 30% of the population (Health Systems Trust, HST, 2008).
The Pharmacy Programme at the University of Limpopo (previously University of the North, UNIN) was started in the 1960s primarily to train African (black) pharmacists, targeting black students from disadvantaged backgrounds. Student selection, however, is largely based on academic performance. The programme presently produces 50 to 60 pharmacists a year (Dambisya & Modipa, 2004), and yet the shortage of pharmacists persists, especially in rural areas. The scarcity of pharmacists undermines some of the health programmes in South Africa. For instance the delay in achieving anti-retroviral therapy targets was largely due to the lack of pharmacists (Joint Civil Society Monitoring Forum, 2007).
As part of the Regional Network for Equity in Health in East and Southern Africa (EQUINET) – East, Central and Southern Africa Health Community (ECSA HC) programme on HRH retention and migration, we have been interested in factors that motivate pharmacists to stay in the public sector and rural areas. We have previously reported on the relationship between matriculation scores and the progress made by students in our programme (Dambisya & Modipa, 2004) and on the factors affecting the distribution of our graduates from 1966 to 2003 (Dambisya et al., 2005). We now report on the profile of existing students and their career intentions.
This was a descriptive, self-administered questionnaire-based study conducted in August 2005.
Subjects: The study population consisted of 169 pharmacy students in levels two, three and four at the University of Limpopo, Turfloop Campus. First level students were excluded from participation. Due to the limited interaction they have with pharmacists and staff in the pharmacy programme, they were not aware of all the options open to pharmacists.
Survey questionnaire: The questionnaire contained both open and close-ended questions on demographics, background and prospective career intentions. It was pretested before being distributed to the 169 students. The purpose of the study (as part of a wider investigation into factors influencing pharmacists’ choices) and its possible benefits to the programme (e.g., development of evidence-based admission criteria) were outlined, and any questions addressed. Student participation was voluntary and responses were anonymous. The questionnaires were typically completed at the end of lecture sessions to minimize inconvenience to the students. The study was approved by the University of Limpopo Research Ethics Committee as part of the wider study on factors affecting the distribution of pharmacists from the University of Limpopo.
Data analysis: Responses from the questionnaires were entered into an MS Excel database from which descriptive statistics were generated. Possible relationships between different variables were tested using a chi-square test of significance (p < 0.05).
Student profile and background: There were 157 completed questionnaires included in the analysis (93% response rate). Fifty-five responding students (35%) were in the second level of study, 43 (27%) in the third level and 59 (38%) in the fourth level, with respective response rates of 90%, 90% and 98%. Sixty-nine (44%) of the respondents were female. Age ranged from 16 to over 30 years, with the majority (69%) between 21 and 25 years old. One hundred twenty-four of the responding students (79%) were of rural origin, with 31 (20%) of urban origin (two students did not respond to this question). Forty-six percent of the students were from the Limpopo Province. Most students (77%) had attended rural government schools, followed by 18% from urban government schools and 4% who had attended private schools. In terms of career preferences, 61 (39%) of the students reported pharmacy as their first choice, 73 (47%) as second choice, 13 (8%) as third choice and 7 (5%) as fourth choice.
Views on the Pharmacy course and Pharmacy profession: Most responding students (72%) would still opt to study pharmacy. This was due to job opportunities, service to community, the fact that pharmacy was their first choice (82% of those with pharmacy as first choice would still opt for pharmacy) and the experience they had in the course (for instance, one student reported pharmacy to be “…a very interesting and challenging course”). On the other hand, 27% of the students would not study pharmacy again, for reasons that included too many professional regulations, need to change direction, low salaries for pharmacists and the fact that pharmacy was not their first choice. Of those who would not study pharmacy again, 24% had pharmacy as first choice, 55% as second choice, 10% as third choice and 10% had pharmacy as their fourth choice. Still, nearly 85% of all students would encourage others to go into pharmacy, while 15% would not.
Work sector and future career paths: Sixty-nine students (44%) indicated they would prefer to work in a government hospital, 34% in industry, with 7%, 6%, 3%, and 5% preferring a private hospital, retail, academia and a combination of sectors, respectively. Those preferring work in a government hospital stated service to community (56%) and the obligation to pay back sponsors (18%) as their main reasons; less commonly cited reasons were good working environment (6%), learning opportunity (4%) and non-specified incentives (3%).
Those preferring to work in private hospitals (n=11) stated the type of service and facilities (45%), incentives (9%), money (27%), learning opportunity (9%) and personal interest (9%) as the reasons for that choice. Similarly, retail pharmacy was chosen because of work environment (20%), money (30%) and service to community (50%). Those who preferred to work in industry provided similar reasons as other sectors, with interest in manufacturing (32%) and research (23%) being the main reasons. Some respondents mentioned personal development (20%), research (20%) and transformation (20%) as reasons for choosing academia.
Age was related to sector preferences – 72% of those under 20 years preferred industry, compared to 27% of those over 20 years (χ2=11.246; p<0.001). There were no statistically significant differences in sector preferences between male and female students and between students at different levels of study.
There were 155 responses regarding future career paths: 81 students (52%) indicated a public sector preference, 28 (18%) the private sector, and 23 (15%) reported a combination of private and public sectors. Thirteen (8%) intended to work abroad, and seven (5%) were uncertain. Two students (1%) reported wanting to leave the pharmacy profession, while one respondent stated no preference.
Place of work: Seventy responding students (45%) expressed preference for working in rural areas. Thirty-one (20%) indicated ‘big city,’ 29 (19%) reported urban areas (but not big city), 24 (15%) planned to go abroad, while three (2%) did not give a workplace preference. Service to community was the main reason (80%) for choosing a rural area, with other reasons being rural incentives, such as the rural allowance and housing (7%), “youth inspiration” (2%), broad exposure (2%) and payback to the community (2%).
Reasons cited for preference for work in big cities were challenge (19%), availability of industries (19%), more opportunities (13%), convenience (6%) and access to more information (6%). Conveniences (28%), service to community (28%) and opportunities for professional development (24%) were also cited for choosing urban areas other than big cities. Those who preferred to go abroad would do so in order to gain experience (17%), due to the state of pharmacy in South Africa (21%), to make money (42%) and also because of more opportunities abroad (13%). There were no statistically significant differences in workplace preferences in relation to rural origin versus urban origin, gender, and level of study.
Most of the UL pharmacy students are of rural origin, and most intend to stay in South Africa to work in the public sector and in rural areas. This is consistent with earlier findings on programme graduates (Dambisya et al., 2005).
Our pharmacy programme is largely traditional, similar to most pharmacy schools in South Africa. The students get only limited clinical exposure in rural facilities during the course, which is unlikely to explain their affinity for rural areas. The rural origin of most students would appear to be the major determinant for the rural preferences, though that does not explain the rural inclination of some urban origin students. The reasons for this selection process by urban origin students are not clear. However, it is important to further study and understand this phenomenon as rural pharmacy needs will likely not be adequately met by rural origin students alone.
A common reason for rural preference given by the students was service to the community, suggesting that they have altruistic intentions towards rural communities. That, coupled with the desire to work close to their homes, may explain the relatively higher proportion of pharmacists in the public sector and rural communities in the Limpopo Province, one of the poorest and most rural provinces in South Africa (Health Systems Trust, 2008). Our finding is in line with reports showing that doctors of rural origin are more likely to work in rural areas than doctors of urban origin in, for example, South Africa (De Vries & Reid, 2003; Igumbor & Kwizera, 2005), the United States (Rabinowitz, 1998; Stearns et al., 2000), Norway (Magnus & Tollan, 1993) and Australia (Peach & Bath, 2000; Eley & Baker, 2006).
It is noteworthy that financial reimbursement was not a major reason for workplace and sector preferences. Past work has shown that many pharmacists in the public sector, where pay is uniform country-wide, placed higher value on “service to the community” and “paying back the community” than on money in workplace choice. The same could be true of the students. Most intend to work in the public sector, and their choices could be driven by non-financial factors such as loyalty to the community. Caffery and Frelick (2006) showed that money has an immediate impact on attracting health workers, but non-financial incentives have a stabilizing influence in their long-term retention in hard-to-staff areas. That is consistent with a report on health worker retention in 16 East and Southern African countries which underlined the importance of non-financial incentives for HRH retention (Dambisya, 2007). South Africa has instituted rural health worker retention incentives that include rural allowances, housing and workplace improvements and community service, but their overall impact has not been evaluated (Reid, 2004).
Part of the loyalty alluded to above may be due to ‘bursaries’ some students receive from their home provinces. The bursaries are grants the students do not pay back, except through working for the province after their studies, on a year-to-year bonding contract. Though bonding has had mixed results as a strategy for retention of health professionals (e.g., Caffery & Frelick, 2006; Schwabe et al., 2004), it is apparently successful among our pharmacy students, despite the small number of bursary beneficiaries. One inference is that if Limpopo Province sponsored more pharmacy students, it would have more pharmacists in its service. The same could cautiously be extended to sponsorship of students of other health professions and to other provinces, bearing in mind the limitations of the study.
Interpretation of the present findings is limited since this was a cross-sectional study in one cohort of pharmacy students at one institution in South Africa, and may therefore not apply to other health professions or other schools. Furthermore, student intentions and preferences may change after completion of studies (Brink et al., 1991; Mutha et al., 1997). However, the pattern of intentions of these students mirrors the distribution of the graduates in the field, which may be predictive of future trends.
This study builds on our earlier work. The data indicate the potential for successful sponsorship-bonding arrangements, and the rural preference of rural origin students and students trained in a rural school, which could help overcome the shortage of pharmacists. We have called for a revision of admission criteria to give special consideration to applicants from rural/underserved areas. That approach will be piloted from 2009, with some places allocated to rural students who may otherwise not get admitted. Such students will then be followed and monitored during their pharmacy careers.
Acknowledgements: We thank the pharmacy students for completing the questionnaires, and our colleagues in the programme - particularly Ms. S. Sathekge - for assistance with questionnaire administration. We are grateful for financial assistance from EQUINET received at the start of the study on graduates of our pharmacy programme.
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Appendix: BASELINE SURVEY OF UNIVERSITY OF LIMPOPO (UL) PHARMACY STUDENTS