Table 1.

Characteristics of studies included

Authors, title, year, country	Study participants	Study design	Pillars of the rural pipeline programme					Rural pipeline programme implementation
			Advocating health professions among rural students	Ensuring that more rural students are selected into programmes	Developing a curriculum oriented towards rural health training and delivery	Ensuring rural retention through educational and professional support	Other pillar	Facilitators	Challenges	Outcomes
Sidibé et al., Rural pipeline and willingness to work in rural areas: mixed methods study on students in midwifery and obstetric nursing in Mali, 2019, Mali	Students in midwifery and obstetric nursing	Mixed-methods	Decentralization of medical schools to rural and underserved locations Entrance test dates are announced and published on radios	Organization of tests in all regions, including rural and underserved regions Allocation of scholarship covering tuition and living expenditures	Existence of a mandatory policy exposing students to rural practices Clinical practices in rural communities during internship	[Not reported]	[Not reported]	No age restriction for students applying to training programme Availability of schools in rural settings	Most candidates from urban areas Admission to private schools is conditional to tuition fees payment Lack of support for subsistence of private school students during internship in rural area Inadequate equipment, poor road network and housing conditions	Current living location in rural areas, having professional school, and having had secondary education in rural areas are greater intention to go to rural areas
Amalba et al. The effect of Community Based Education and Service (COBES) on medical graduates’ choice of specialty and willingness to work in rural communities in Ghana, 2016, Ghana	Medical students	Cross-sectional	[Not reported]	[Not reported]	As part of the Community-based Education services (COBES) programme, for the 3 first years, students are sent to communities, with at least a primary health care facility Each of these 3 years, students spend four weeks in the community in groups of 8–10 students per community Students are expected to identify and explain factors (e.g. demographic, economic, social, political and environmental) that affect the community health, and subsequently prioritize them and identify the resources available in the community to contribute to meeting those needs Students take turns to rotate through the various sections of the health facility (e.g. for example, dispensary, consulting rooms, MCH clinic, laboratory, and immunization programmes)	[Not reported]	[Not reported]	[Not reported]	Scarcity of medical schools in rural areas	Programme develops graduates to adapt to rural lifestyle; which results in high future intention practice in rural areas Graduates learn the culture and lifestyle of the community when they interact with community members; hence their willingness to go back to the community after graduation becomes strong
Hatcher et al. Placement, support, and retention of health professionals: national, cross-sectional findings from medical and dental community service officers in South Africa, 2021, South Africa	Medical doctors and dentists	Cross-sectional	[Not reported]	[Not reported]	A year of compulsory community service for young professionals The programme started with medical doctors, dentists and pharmacists and grew to include physiotherapists, clinical psychologists, dieticians, radiographers, environmental health practitioners and nurses	[Not reported]	[Not reported]	Graduates reported greater satisfaction with supervision, management, and practical concerns during the community service year. In terms of supervision and management, most felt well-oriented to the job (87%) and reported that seniors were available when needed (82%). Approximately three quarters felt they had good clinical supervision (71%) as well as satisfactory mentorship and support (72%)	Approximately half reported accommodation as unsatisfactory (43%), their personal safety as lacking (66%), and remuneration as unfair (46%)	More than half (55%) of graduate were placed in rural areas High proportion of health workers intended to remain at the same facility (34%) and one quarter (25%) intended to work in rural and underserved communities Among those who intended to leave, 68% intended to specialize
Amalba et al. Training preferences regarding choice of place of work after completing medical training in traditional or problem-based learning/community-based education and service curricula: a study in Ghanian medical schools, 2019, Ghana	Medical students	Cross-sectional	[Not reported]	[Not reported]	Similar to what is described above (COBES programme)	[Not reported]	[Not reported]	[Not reported]	Country medical education mainly concentrated in urban cities Inadequate infrastructure of health facilities in the rural communities Rural outreach programmes not incorporated in curriculum Discriminatory admissions policy for students in rural areas	Increased willingness to practice in rural area Male students were 1.5 times more likely to indicate that they were willing to work in rural areas after graduation compared to their female counterparts Students who had lived in rural areas prior to entering medical school were almost four times more likely to choose to work in a rural area after graduation than those from the city
Clithero-Eridon et al. Future medical student practice intentions: the South Africa experience, 2020, South Africa	Medical students	Cross-sectional	[Not reported]	[Not reported]	[Not reported]	[Not reported]	Social accountability principles guide the rollout of this strategy The Network Towards Unity for Health (THEnet) is used to measure progress towards meeting the educational component of this vision including examining socio-demographic and practice intention characteristics. For example, with the THEnet methods, students selected into the training programme should demographically mirror the population they are expected to serve	[Not reported]	[Not reported]	One-third (34%) of respondents indicated an intention to go into primary care, A similar proportion of female (36%) and male respondents (38%) indicated a plan to enter primary care Less than one-third of students (27%) indicated they would go abroad after graduation Reasons for leaving was to gain experience and the belief that there were better opportunities overseas Black African respondents were significantly less likely to state an intention to work abroad than other respondents
Gumede et al. Engaging future healthcare professionals for rural health services in South Africa: students, graduates and managers perceptions, 2021, South Africa	Medical students	Qualitative study	[Not reported]	Intervention invoking an integrated model of students’ recruitment at school level through selection by local health facilities Allocation of scholarships to disadvantaged students in rural provinces	[Not reported]	Upon completion of their degrees, graduates are absorbed into the hospitals where they were initially interviewed for the scholarship The selected graduates sign a year-for-year work-back contract with programme	Social mentoring programme that aims to prepare students for life at university and away from home, and to cope during difficult times	[Not reported]	[Not reported]	Programme brakes the cycle of poverty for needy students, by introducing career guidance, informing them of work opportunities in the healthcare field, and making it possible for them to complete the necessary courses Students had become role models for rural youth; local graduates act as a point of reference for youth who do not value education and drop out of schools Patients can now access health services without needing interpreters to convey the message to the health care practitioners Improved communication with grassroots communities as students/graduates speak local language; they understand the community needs and are willing to go the extra mile to provide quality healthcare. This not only helps to produce a stable workforce but makes it possible for the hospitals to have outreach services to prevent the spread of diseases in the community
McGregor et al. The socio-economic impact of rural-origin graduates working as healthcare professionals in South Africa 2019, South Africa	Medical doctors, nurses, dentists, pharmacist, etc,	Mixed-methods	[Not reported]	Selection of rural origin students from poor family Allocation of scholarship to students from rural areas	Graduates are expected to return to the district hospital where they were selected to fulfil a year-for-year work-back obligation	[Not reported]	[Not reported]	Available of funding Support of national Stakeholders including local communities	Poor infrastructure, inadequate human resources and reduced teaching capacity of schools located in rural areas	From 1999 to 2016, 337 rural-origin students were trained In 2017, 145 health professionals (out of the total 337 graduates) had completed their work-back obligation; 63% of them were still working in rural health facilities Health professionals trained under this programme witnessed major changes in their household economic and social circumstances as soon as they started working as health care professionals It costed 184 million South Africa Rand ZAR Rand, ZAR (equivalent of 11.5 million USD) to train 254 graduates. These graduates’ lifetime earnings were estimated at 4 billion ZAR (251 million USD)
Kapanda et al. Enhancing future acceptance of rural placement in Tanzania through peripheral hospital rotations for medical students, 2016, Tanzania	Medical students	Cross-sectional	[Not reported]	[Not reported]	Exposure of medical students to rural working environments; in 2012 a 12- week peripheral hospital rotations initiative was introduced for third-year medical students	[Not reported]	[Not reported]	[Not reported]	Most secondary schools in rural areas are ill-equipped with laboratory spaces and lack science teachers to prepare them for admission in medical schools; this disadvantage rural students in selection processes by medical schools Poor infrastructure in rural areas (lack of electricity, poor roads, and general poverty of rural populations) hampers the establishment of medical schools in rural settings, and as a consequence most medical schools are located in urban centres	Students exhibited positive attitudes toward peripheral hospital placements Students with male gender, aged 25 years or above, enrolled after health-related practice (in-service), born in rural area, being satisfied with peripheral hospital placement were likely to accept deployment in rural locations after graduation
Kizito et al. Influence of community‑based education on undergraduate health professions students’ decision to work in underserved areas in Uganda, 2017, Uganda	Medical students	Before-and-after study	[Not reported]	[Not reported]	As part of the Community-based Education, Research and services (COBERS) programme, students are sensitized and acclimatizes to working in underserved communities and to enable them acquire the appropriate attitudes towards working in these areas COBERS is compulsory for medical, nursing, dentistry, pharmacy, biomedical engineering, cytotechnology, radiography and medical laboratory sciences students	[Not reported]	[Not reported]	COBERS was established with funding from the US Government through the Medical Education Partnership Initiative and technical support from Johns Hopkins University	[Not reported]	After the COBERS placement, factors that were significantly associated with choice to work in the rural areas included access to long distance, and being posted in the rural areas by the ministry Factors associated with intended duration of work in the rural areas after students had undergone a COBERS placement included university attended, availability of reliable electricity, access to long distance medical courses, and having the intention to work in another African country
Couper et al. Influences on the choice of health professionals to practise in rural areas, 2007, South Africa	Medical doctors	Mixed-methods	[Not reported]	Priority selection of students from rural origin	Exposure of students to rural health delivery during training and education	[Not reported]	[Not reported]	[Not reported]	[Not reported]	Decision to work in rural area is underpinned by personal attributes, including: serving people (especially one’s ‘own people’), having a community connection, wanting to serve people in rural areas and the need to make a difference and have an impact For those of rural origin, the greatest motivating factors was sense of returning home, and of familiarity with and ability to relate to rural people, coming back to roots, family, people, and village and being born there Some felt a sense of obligation, needing to give something back to the community which had nurtured and supported them, because ‘my success is the community’s success’
Mapukata et al. Factors influencing choice of site for rural clinical placements by final year medical students in a South African university 2017, South Africa	Medical students	Explanatory qualitative study	[Not reported]	[Not reported]	A Wits (Faculty of Health Sciences at the University of the Witwatersrand) programme was launched in 2003 as a 4-year training programme that complemented the existing traditional approach to medical training, with both streams being combined in the clinical years. Within that, the integrated primary care block, which is a compulsory 6-week placement in a range of primary health care settings, was launched in 2006 as one of the initiatives that would strengthen the university’s and students’ commitment to rural and underserved communities. Through the IPC block, district facilities in underserved communities of four provinces (Gauteng, North West and Mpumalanga) provide the context for final year medical students to achieve some of the core competencies of an integrated curriculum	[Not reported]	[Not reported]	Good supervision was reported to influence students’ choice of rural sites Existence of comfortable accommodation, and provision of three meals per day at no cost to the student	[Not reported]	[Not reported]
Mpofu et al. Impact of an interprofessional education programme on developing skilled graduates well-equipped to practise in rural and underserved areas, 2014, South Africa	Medical students	Mixed-method	[Not reported]	[Not reported]	The Faculty of Community and Health Sciences (FCHS) at the University of the Western Cape (UWC) has, therefore, developed a specialized South African Inter-Professional Education (IPE) programme that provides health sciences students with structured learning opportunities that combine service learning with teamwork and reflection The programme offered required students in the disciplines of Natural Medicine, Physiotherapy and Nursing in their third and fourth years to address collaboratively identified community priorities. These priorities were identified by UWC together with community and health service providers Students were expected to work in interdisciplinary teams and initiate community interventions for the identified priorities. They were engaged in a process of structured reflection during the IPE course and delivered a presentation to the community at the end of the placement. Students were supervised once a week according to their disciplines by selected academics with the requisite knowledge, skills and experience, as well as by on-site professionals working in the practice settings	[Not reported]	[Not reported]	[Not reported]	[Not reported]	The majority of the students (69%) preferred to work in rural-based communities with less than a third of the group preferring to work in urban-based communities Students indicated that the need for health promotion in the community and the community’s friendliness motivated them to want to practise in the rural areas and to work there in future Some students want to work in rural areas in order to address the problem of limited resources Other students also felt that their personal needs, such as their desire to earn more money, would not be satisfied in a rural setting
Tonya et al. Rural exposure during medical education and student preference for future practice location—a case of Botswana, 2016, Botswana	Medical doctors	Mixed-methods	[Not reported]	[Not reported]	Exposure of students to rural health care delivery throughout a 5-year curriculum Rural rotations of students during their training curriculum	[Not reported]	[Not reported]	[Not reported]	94% of graduates perceived poor opportunities for career advancement Career stagnation, lack of learning opportunities, and professional isolation Absence of monetary compensation in a context of rural isolation, lack of basic infrastructures (eg: regular water supply, good schools for children)	The majority (91%) of graduates wanted to practice in urban areas. However, 31% said it was likely/very likely that they would practice in a rural area Rural rotations showed them that practising in a rural area is not as difficult as previously perceived Students with a rural background were more likely to practice in a rural area if it was near their home towns
Strasser et al. Increasing nursing student interest in rural healthcare: lessons from a rural rotation programme in Democratic Republic of the Congo, 2021, RD Congo	Nurses	Case study	During the alignment phase of the rural rotation (RR) programme, meetings were conducted with the Ministries of Health and Education, Nursing Council, Midwife Association, target schools, students, and students’ parents to raise awareness of the subject by explaining to them the requirements of Education Reform using a competency-based approach: train students to be future health workers on a global scale; and prepare them to work in all conditions, even in the remote environments both in hospitals and in rural communities	[Not reported]	The RR programme aimed to increase nursing students and community health worker (CHW) exposure to rural health needs as well as rural clinical practice and community engagement prior to graduation, entry to practice, and employment The programme also focused on nurses’ readiness for clinical practice through curricula reform and development of innovative pedagogy including use of skills labs and simulation-based training	The RR programme included the development of a tele mentoring programme to bridge rural health centres with urban specialists and trainers as well as assistance with national registration of nurses	[Not reported]	Availability of PEPFAR funding to support HRH strengthening in DRC	Lack of financial support for students, poor housing and living conditions in rural areas	93% of students agreed or strongly agreed that they would recommend RR participation 97% agreed or strongly agreed that their RR had strengthened their educational experience 95% of students agreed or strongly agreed that they felt better equipped to provide HIV/AIDS prevention, care, and treatment services after RR participation When asked about their biggest RR challenges, students most reported financial support (35%), housing (30%), and rural living conditions (3%)
Kelly et al. Predictors of Workforce Retention Among Malawian Nurse Graduates of a Scholarship Programme: A Mixed-Methods Study, 2015, Malawi	Nurses	Mixed-methods	[Not reported]	Global AIDS Interfaith Alliance offers preservice scholarships for nurses who need assistance with college fees and who demonstrate a commitment to work in the public health system after graduation The scholarship programme supports nursing students who are predominantly orphans or from lower socio-economic backgrounds; the scholarship recruitment phase targets needy students who have been accepted to nursing college (including one located in and serving a rural area) who are facing financial hardship and would otherwise be unable to complete a diploma/degree in nursing	[Not reported]	GAIA maintains close follow-up with each scholar through site visits, text messaging, phone calls, and regional get-together events, providing academic assistance, psychosocial and clinical mentoring, and educational support, including opportunities for continuing professional development. GAIA staff maintain follow-up data on all graduates in a continually updated database GAIA’s follow-up activities assist the Ministry of Health with tracking whether GAIA scholars have reported to deployment sites	The scholarship programme aims to increase the number of nurses working in the public sector in 2 ways: by providing tuition support, living stipends, uniforms, nursing supplies, and payment of council exam fees to improve yearly school progression of nursing students, on-time graduation rates, and licensing exam performance; and by requiring students to sign a service agreement to work for the Ministry of Health for 4–5 years after graduation from nursing school to retain them in the public sector	Feeling appreciated by their supervisors and emphasized positive relationships with co-workers as factors associated with remaining in their current job Job security, continuing education, and public service agreement	Lack of resources and high nurse-to-patient ratios Poor working relationships with management or other nurses Low salaries in relation to workload, poor housing options, and lack of appreciation	Most of the graduates were working in urban areas (67% urban, 23% rural, and 10% peri-urban)
Amalba et al. The perceived usefulness of community-based education and service (COBES) regarding students’ rural workplace choices, 2016, Ghana	Medical students	Mixed-methods	COBES aims to create awareness among students of the importance of developing community partnerships as a means to implement sustainable healthcare initiatives	[Not reported]	On yearly basis students spend four weeks in the community with predefined objectives until year four. In year five and six, they are scheduled for community posting at district hospitals	[Not reported]	[Not reported]	Existence of partnerships between the university, service providers and community as well as the students’ learning and service activities, positively influences and prepares students to care for people in the rural communities	Insufficient motivation of staff and lecturers to spend adequate number of days in guiding the students in the communities The lack of basic equipment at the facility level	The community sees the relevance of health promotion and education. As the students give talks on health education and carry out health promotion activities, the behaviour of the community, as well as their health seeking behaviour changes and their awareness towards health and their knowledge on health issues improve The presence of the students in the community serves as motivation for the youth. In the northern part of the country where most families do not see the relevance of children’s education, parents do not invest in their education. Encountering female students may convince parents that educating the female offspring can be very rewarding Participants indicated that the presence of students in the community provides workforce to the community. They are also able to identify the needs of the community and propose solutions with the support of the community members Participants alluded to the fact that students do benefit a lot from COBES activities in the communities. Stakeholders acknowledged that the community serves as a learning platform where students interact with people of different cultural backgrounds. This helps them improve their communication skills, help to build their clinical and social skills and empowers them in their clinical work COBES helps students get a clear understanding of primary health care setting within the health structure. Having part of their training in the community helps them to make choices as to which areas they want to specialize and also develop interest to practice in the rural area after graduation Some of the health facility staff were of the opinion that since most of those who guide the students in the community are community health nurses, the University, as a way of incentive, could offer some of them admission into the University to pursue further studies to better guide the students who are more knowledgeable than them
Atuyambe et al. Undergraduate students’ contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda, 2016, Uganda	Medical students	Qualitative study	[Not reported]	[Not reported]	The programme exposes students to health delivery in rural communities Before students go to the sites, they are briefed and are given overview lectures that introduce them to community health, Primary Healthcare and what to expect during their COBERS attachment	[Not reported]	[Not reported]	Uganda had, in 2016, 6 preservice medical training institutions. Five of them (Universities of Gulu, Makerere, Mbarara, Kampala and Busitema) came together to form Medical Education for Equitable Services to All Ugandans consortium (MESAU) with funding from the US Government supported Medical Education Partnership Initiative (MEPI) and technical support from Johns Hopkins University	Inadequate, and in some cases total absence of transport for outreaches to communities was a key constraint to students’ activities and to reach at some sites In some cases, medicines and other supplies like gloves were limited which meant that students could not effectively meet the demand in the communities	Students were not only learning; they were also contributing to health service delivery Students’ contribution at the health facilities was described in various ways which we grouped into five categories during analysis. Students were described as: being caring and compassionate, available on time and anytime, participating in patient care, willing to help and share their knowledge and skills, and stimulating discussion on various topics in health as well as inspiring health workers regarding work ethics COBERS students participated in various community health activities in the areas of water and sanitation and hygiene. Students contributed to maintenance of safe water sources, educated communities on drinking safe water in the households and on good sanitation practices including latrine construction, hand washing and appropriate waste disposal. Hygiene was promoted at household level and at community level for example among food handlers in markets. Public health education extended to institutions such as schools where sensitization on various health-related issues including sexuality and sexual health was conducted Students presented extra workload for some health workers (supervisors) Other health workers reported that they spent more time on each patient because they had to explain to students as they provided patient care Some patients did not appreciate being attended to by students with the effect that the number of mothers coming to the facility for delivery during COBERS placement was reduced Some health workers (supervisors) perceived the presence of COBERS students as an opportunity to take unofficial leave thus leaving students unsupervised
Kaye et al. Influence of the training experience of Makerere University medical and nursing graduates on willingness and competence to work in rural health facilities, 2010, Uganda	Medical students, nurses	Participatory approach	[Not reported]	Allocation of social amenities and affordable cost of living to students from rural areas	[Not reported]	[Not reported]	[Not reported]	Availability of social amenities and affordable cost of living; ease of communication (no language or cultural barriers); personal safety and security considerations; the opportunity for career advancement; and considerations about workload	Inequitable and poor remuneration, overwork due to understaffing, having no time for holidays, and the overwhelming responsibilities of clinical care, planning and administration in the context of limited resources or prior experience work environment lacking stimulation and characterized by inadequate supplies, equipment and support supervision from the ministry of health or district officials, and low access to continued professional education	Community based training was identified as the main factor shaping the values and attitudes of those who were in favour of rural practice, and were confident and willing to work in a rural area. The interaction of medical and nursing graduates with the community during the community based training curriculum appeared to prepare trainees for rural practice by changing their attitude to working in a rural area
Kaye et al. Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda, 2010, Uganda	Medical students, nurses	Qualitative study	[Not reported]	[Not reported]	Experiential training on community placements and working in rural areas	[Not reported]	[Not reported]	[Not reported]	Whereas only about one third had their home district in the central region, over 3 out of 4 completed their high school from schools located in the central region, and possibly were not conversant with rural areas Being cut off from friends and colleagues, absence of guidance from faculty or any tutors and inadequate exposure to the variety of conditions, which exist in the large teaching hospital Inadequate support facilities like internet and libraries to enable self-directed learning, and inability to understand the local languages or cultures	This community-based education programme was reported to enable students understand the medical conditions in rural areas, to see a variety of medical conditions (some of which are not seen in the teaching hospital), and to learn about the management of the health care system
Schalkwyk et al. Consequences, conditions and caveats: a qualitative exploration of the influence of undergraduate health professions students at distributed clinical training sites, 2018, South Africa	Medical students	Qualitative study	[Not reported]	[Not reported]	In recognition of the need for more socially relevant training, undergraduate health professions students were sent to district and community health facilities (within the public healthcare system) as part of their clinical exposure	[Not reported]	[Not reported]	[Not reported]	[Not reported]	Having students at the site manifested in the organizational culture and the ways in which staff at the facilities engaged with one another. For example, respondents spoke about the way in which bringing the academic endeavour to the facility had a ripple effect on the culture in the facility by encouraging the adoption of a more evidence-based approach Students were involved in. In the health facility, for example, they assisted with history taking and examination of patients, the clerking of patients, dealing with emergencies, and performing certain simple procedures. The allied health students provided therapeutic interventions. In the community context, students conducted. Quality Improvement and Community Oriented Primary Care projects, and were involved in health promotion, patient follow-up and home visits. In performing these clinical activities, students added to service delivery by doing more in-depth as well as comprehensive assessments of patients, being able to see patients more regularly than qualified clinicians, and assisting facility staff in patient care Supervisors enjoyed the opportunity to interact with students. This was often expressed in terms of conveying their own enthusiasm and interests to future health care professionals
Dormael et al. Appropriate training and retention of community doctors in rural areas: a case study from Mali, 2008, Mali	Medical doctors	Participatory action research	[Not reported]	[Not reported]	[Not reported]	In response, the NGO and the Rural Doctors Association decided to set up an orientation course for recently established rural doctors. The underlying assumption was that training meeting rural practitioners' needs would strengthen young doctors' technical competences and self-confidence, and consequently contribute to retention Rural practice is promoted through a package of non-financial incentives provided by an NGO (Santé Sud) and the Malian Rural Doctors Association: young doctors settling in rural areas usually benefit from interventions aiming at improving living conditions (water, solar panels, motorbike) and working conditions (basic equipment, continuous education, peer support and mentoring)	[Not reported]	[Not reported]	They reported frequent relational problems detrimental to their social integration: conflicts with the health centre committee (their employer) about working conditions and financial management issues, leadership conflicts with other staff members, absenteeism and misbehaviour of staff, tense coexistence with traditional practitioners, or disagreements with the district medical officer concerning boundaries between first line care and hospital care	Between 2003 and 2007, 65 newly installed rural doctors, deployed in all regions of the country, participated in the training. Table 3 shows yearly cohorts and retention in rural practice over the years. At the end of 2007, 55 out of the 65 trained young doctors (85%) were still engaged in rural practice Regarding the three first cohorts trained in the period 2003 to 2005, respectively, 50%, 77% and 86% were still in rural practice 4, 3 and 2 years after the training. Eight out of 32 trainees for this period were no longer in rural practice end of 2007; five of them left within the two first years of installation. The 8 "dropouts" went for specialist training, got involved in a private practice in the capital city Bamako, or were hired by an NGO
Coulibaly et al. Une médecine rurale de proximité: l'expérience des médecins de campagne au Mali, 2007, Mali	Medical doctors	Mixed-methods	[Not reported]	[Not reported]	[Not reported]	Prior training is offered to young people setting up, as well as regular follow-up. The support of the professional association plays a crucial role in the fight against professional isolation: regional and national meetings, continuous training, mutual visits, etc. Several factors, both financial and non-financial, contribute to the acceptability of working in rural areas. Young doctors are encouraged by professors from the Faculty of Medicine. The Santé-Sud project supports them by providing an installation kit, solar panels and a motorbike	[Not reported]	[Not reported]	[Not reported]	The presence of a doctor increases the use of services. The utilization and coverage rates of preventive activities of centres run by eight experienced rural doctors were higher than those of other centres in the same districts. Some centres with doctors attract many patients from outside their area A reduction of more than 80% in the number of epileptic seizures of patients followed by the field doctors. Prior training is greatly appreciated by young doctors, who say they are better prepared to face field practice A relative stability of rural doctors: 45% had been practising for more than 5 years, and 25% planned to practise for more than 10 years