Analysing the costs of an innovative strategy to train and improve the healthcare workforce in rural KwaZulu-Natal, South Africa

Abstract Background: To improve health in low- and middle- income countries in addition to improving the basic health infrastructure, requires addressing the shortage of skilled healthcare professionals (HCPs), particularly in rural areas. The Umthombo Youth Development Foundation (UYDF) is a non-profit organisation established in 1999 to assist in addressing the shortage of HCPs in rural areas. The aim of this study is to describe the role played by the UYDF in addressing HCP shortages in rural hospitals by calculating the cost-benefits and internal rate of return and reporting the progress of the UYDF bursary scheme in achieving this goal. Methods: An economic analysis (cost-benefits and internal rate of return) was used to estimate and describe strategies used by the UYDF to improve shortages of HCPs in the health sector. This study presents a summary of the model and the UYDF achievements since 1999. The sources of data were the UYDF organisational records (finance, human resources and procurement), supplemented by the published and unpublished UYDF reports. The return on investment was estimated through the use of an Internal Rate of Return (IRR) calculation.Results: The results indicate that the UYDF provided bursaries to rural youth to address the shortages of HCPs. The UYDF database showed that by 2017 a total of 337 HCPs had graduated and a further 254 were still studying. An average of ZAR 17 million (US$ 1.278 million) was spent every year on the students or ZAR 102 015 (US$ 7 219) per student per year. The IRR was encouraging being 63% higher than the interest rates on commercial loans. The UYDF graduates are expected to generate an estimated ZAR4 billion (US$ 62 479 million) in lifetime earnings at current prices.Conclusions: The UYDF scheme demonstrates the potential to reduce the shortage of HCPs in rural hospitals, where the hospitals were able to retain the services of many now qualified locally sourced HCPs. The costs of implementing the bursary scheme were outweighed by the income generated from salaries, and their taxes contribute to the country’s economy. This analysis has shown that the investment gives a multifactorial return and contributes to the socioeconomic development of the individuals, their community and the country.