Beyond the Rural Pipeline Approach: Policy Considerations in the Making of a Rural Workforce

The enduring health workforce crisis, which has culminated in the maldistribution of healthcare professionals, particularly in rural South Africa, is considered a global challenge. This crisis was further exacerbated by the emergence of the novel coronavirus in 2019. In 2020, as part of a doctoral thesis, an examination was conducted into the influence of habitus in the professionalisation of twenty-one rural-origin final-year health sciences students studying at the University Cape Town to become doctors and health and rehabilitation therapists. Using an integrative methodology, the literature on pipeline strategy, which was presented two decades ago as a preferred approach for recruiting and retaining a rural health workforce, was reviewed. Furthermore, the relationship between policy and practice implementation was examined, along with an evaluation of universities’ contributions to meeting the health needs of South Africans. As an outcome of this policy review, solutions to address ongoing workforce challenges are presented. Participants’ lived experiences revealed that, despite having a generative habitus that had the capacity to transform, poor policy implementation and universities’ failure to meet transformation targets had implications for their practice. Thus, beyond the rural pipeline, a multimodal approach is proposed as an alternative to making a rural workforce.

Transdisciplinary contribution: The successful implementation of key priority areas could contribute to attaining universal health coverage in South Africa and beyond.

Keywords: health workforce; multimodal approach; pipeline approach; policy review; rural workforce