Table 2.

Contextual information about these health professional courses, their structure and setting and their relationships with local health services.

Country	Medical education context*	Relationship between health system and educational planning	Health professional school, foundation year, (year of joining graduate outcome study)	Training structure (size of entry cohort of medical students in 2013)	Priority population	Participants n (response rate, %)
The Philippines	Population density 358 people/km2 Gross national income per capita $7290 (2012) 40 medical schools Physician density 1.3/1,000 (2010) Poor recognition of general practice/primary care as a specialty, but many graduate with public health qualifications. Weak US-style family medicine training and certification	Historically poor coordination between health professional education and health systems Patients can self-refer to specialists, bypassing primary care. Strong and largely unregulated influence of pharmaceutical sector Largely privatized higher education system, and large wage disparities between public and private systems for healthcare workers Maldistribution - <10% of graduates serve rural areas Health training as an export industry - high rates of medical and nursing emigration	Ateneo de Zamboanga University School of Medicine, (AdZU) Zamboanga City, Mindanao. 1993 (2013) School of Health Sciences, University of the Philippines, (SHS) Palo, Leyte. 1976 (2013)	Four-year graduate MD training, about 50% community based. One year internship, 50% in rural health units, emergency and district hospitals (48 students) Five-year graduate MD program. Multilevel entry stepladder curriculum. Six months in Year 2 and all of Year 5 in rural community practice setting Also trains community workers/midwives and nurses)(15 students)	Rural underserved areas of Mindanao, especially Zamboanga peninsular and outlying islands Rural underserved populations in the central Philippines Indigenous peoples	Entry 216 (87.4) Exit 150 (84.7) Entry 33 (89.2) Exit 50 (72.5)
Sudan	Population density 25 people/km2 Gross national income per capita $3220 (2012) 29 medical schools (8 private) Physician density 0.3/1000 (2017) Role of primary care in health system underdeveloped and undervalued in health system Two year community-oriented postgraduate training in family medicine developed in partnership with Gezira Ministry of Health	Four older medical schools, then rapid proliferation of new schools mostly in Khartoum. Perceived decline in training standards Widespread emigration of health professionals for social and economic reasons In last decade partnerships between education institutions, Ministry of Health and Education to progress training for primary health care, including an initiative through U Gezira (17) Feminisation of medical workforce caused issues in rural coverage and workforce (18)	University of Gezira Faculty of Medicine, Gezira State. 1975 (2013)	Five-year undergraduate training program Twenty percent of time allocated for community-based education (270 students)	Rural underserved areas in Gezira region	Entry 805 (66.6) Exit 59 (29.6%)
South Africa	Population density 48 people/km2 Gross national income per capita $11,970 (2012) Nine medical schools Physician density 0.9/1,000 (2017) Four year postgraduate community-based training program (UK/Aust style) for family medicine—specialist recognition	Previously limited coordination between HRH training and deployment with no integrated data source for HRH planning, despite HRH making up almost 2/3 of public health expenditure. Previous planning efforts not implemented Absolute shortages in HRH, especially beyond urban centers, and in public sector, with high professional emigration	Walter Sisulu University Faculty of Health Sciences (WSU) Mthatha, South Africa. 1985 (2013)	Six year undergraduate program, rural experiences in Years 1–3 and 6 months in Year 5 Also trains Clinical Associates (PAs) (120 students)	Rural underserved areas of Eastern Cape and KwaZulu Natal provinces	Entry 563 (91.4%) Exit 102 (58%)
	Tension between health policy focused on public PHC (without a clear role for family physicians) and health system with strong specialist and hospitalist focus	Introduction of National Health Insurance has spurred more coordinated efforts and integrated planning through the NHI Fund, although still in its infancy (19, 20)
Nepal	Population density 196 people/km2 Gross national income per capita $2,170 (2012) 19 medical schools (15 private) Physician density 0.75/1,000 (2018) Three year postgraduate medical training program in general practice to address rural doctor shortage Lack of well-defined career pathway for general practice with limited ability to serve the rural population or strengthen PHC approach due to health system factors that favor speciality practice (21)	Poor staff performance in terms of productivity, quality, availability, and competency Fragmented approach to HRH planning, management, and development Imbalance between supply and demand, and narrow skill mix Limited HRH financing Low attraction/retention in public service, and “brain drain” largely due to the migration of health workers (22)	Patan Academy of Health Sciences (PAHS) Patan, Nepal 2008 (2019)	Five year undergraduate problem-based learning curriculum. Not-for-profit institution. Adapted for local priority issues and priorities. Selective recruitment prioritizing rural students and extensive rural community placements (65 students; 2019)	Rural underserved areas, the poor and diverse ethnic groups, particularly those in northern and Western Nepal	Entry 130 (100%)
Australia	Population density 3 people/km2 Gross national income per capita $41,590 22 medical schools Physician density 3.7/1,000 (2017) Strong postgraduate training program (3–4 years) for general practice with independent certification exams General practitioners and “rural generalists” have well-recognized role as gatekeepers and work in private practices, community health centers, rural hospitals and community-controlled health services	Well supplied in terms of numbers of doctors and nurses but ongoing problems with vocational (insufficient generalist) and geographical maldistribution Various incentives and policies introduced to address these with variable success Separate Ministry for Health and Education, but relatively cohesive and functional mechanisms to create joint planning—e.g., Medical Training Review Panel (23) Reducing earlier reliance on international medical graduates Attention to entire rural pathway demonstrated to produce successful outcomes	James Cook University College of Medicine and Dentistry (JCU) Townsville, Queensland 2000 (2013) College of Medicine and Public Health (FU) Adelaide, South Australia. 1995 (2013)	Six year undergraduate MBBS program, entirely regional, including 20 weeks in small rural and remote settings Also trains dentists and Physician Assistants (238 students) Four year graduate program based in Adelaide or in Darwin. Option for 1 year Parallel Rural Curriculum (30 students) (160 students)	Rural, remote, Aboriginal and Torres Strait Islander populations, and others in tropical Australia Rural, remote and Aboriginal and Torres Strait Islander populations	Entry 1,367 (83.1%) Exit 509 (42.0%) Entry 480 (74.2) Exit 167 (57.5)
Canada	Population density 4 people/km2 Gross national income per capita $41,170 (2012) 17 medical schools Physician density 2.3/1,000 (2016) Family medicine is a strong, recognized specialty and gatekeeper to specialist care School based family medicine programs with defined curriculum and an end-point examination	HRH comprise a large part of health expenditure Strong system of universal access and coverage through family practice, rural hospitals and regional/urban hospitals Parallel private health system Limited processes to track predicted actual and predicted health workforce over time at national level (although some local initiatives) and some national descriptive data.	Northern Ontario School of Medicine (NOSM) Thunder Bay and Sudbury, Canada. 2005 (2016)	Four year graduate program. Entirely regional. Twelve weeks Indigenous and rural community placements plus 8 month community longitudinal integrated clerkship (64 students)	Rural, Indigenous, Francophone and general population of Northern Ontario	Entry 255 (99.2%) Exit 192 (98.5)

^*From World Health Organization Global Health Observatory (http://apps.who.int/gho/data/node.country) and World Bank (https://data.worldbank.org/indicator/). Most recent available data point used.