Table 2 The participants views (students, graduates and management)

Main Themes

Quotes from IDI’s

1. The poor quality of schooling in rural areas

‘… I had never seen a computer, let alone used one and when I came here, I was told to type in assignments …., so it is difficult – you end up handing in assignments late’

‘I have never done experiments in my life …. But my lecturer expected me to be able to do the experiment and produce the report …. (Pharmacy Student, 22 years, Female, Hospital B)

“In my first year, I hadn’t done chemistry in eleven years [of schooling] … … I was struggling in this module and when I went to consult my chemistry lecturer, I was told if I didn’t understand the basic concepts of chemistry then I chose the wrong career … I am doing my second year I repeated my second year …. They gave me another chance although I had to explain why I failed …” (Pharmacy Student, 24 years, Female, Hospital C)

2. Rural-urban migration

“… there are not even traffic lights in KwaNongoma and when you come here there are a thousand of them …., you just wonder how to cross this road.” (Medical Student, 21 years, Female, Hospital B)

“During all my basic education I used one classroom, or if we had to move, we were escorted by a teacher … … when I got to university, I was now expected to move from one lecture hall to another ….” (Physiotherapy Student, 20 years, Female, Hospital A)

“In my first week at university I missed almost all the morning classes as I was expecting to hear the bell ring, but this was not the case here …” (Audiology Student, 20 years, Male, Hospital B)

3. The UYDF intervention

“… given such an opportunity all I can do is study and pass and become the best radiographer …. This is not just bursary, the programme offers more, and we are like a family.” (Female Student, 23 years, Female, Hospital A)

4. Home Away from Home

“… Umthombo [UYDF] is like home to me. Any time you can call if you have a problem with money, Dumsani [the chief mentor] is there to take you through and they always help you ….” (Medical Student, 30 years, Male, Hospital C)

5. Post study placement anxiety

“…. I would say the UYDF made a good plan by signing the MOU [memorandum of understanding] with Department of Health, because as UYDF graduates we have no problem of finding jobs, unlike many graduates in South Africa” (Medical Student, 28 years, Male, Hospital A)

“…. People who graduate are not guaranteed jobs in South Africa. UYDF graduates are kind of lucky because of the MOU with the Department of Health that tries to place the UYDF graduates back in their rural hospitals without any interviews ….” (Medical Student, 26 years, Male, Hospital B)

Main Themes

Quotes from FGD’s

1. The impact of the UYDF intervention on the personal lives

‘… I come from a poor family and I never thought my family could afford tertiary education for me …. Without UYDF, I would not have made it this far ….’ (Graduate, 42 years, Male, Hospital A)

‘… as a student I would budget my money and sometimes buy a few things for my siblings but now that I am working life has changed and whatever my family needs, I make sure I provide it. That’s how good UYDF has been for me...’ (Graduate, 27 years, Female, Hospital A)

“…. I love my community that much; I want to see it prosper and the only person to bring that change is me …’ (Graduate, 31 years, Female, Hospital C)

‘… We are willing to start a fund where we can put as little as R100 in future it will help other students who are in the same situation as we were …. Even if it goes towards their studies in other professions … …’ (Graduate, 39 years, Male, Hospital B)

2. The Impact of UYDF at Community level

‘… there are some things that my rural home people cannot explain clearly to a white doctor or nurse because they do not know how to say it in their language … .it is now easy to talk to us because they are able to say it in isiZulu’ (Graduate, 28 years, Female, Hospital B)

‘… it is no longer necessary for people in the rural areas to have appointments scheduled in the peri-urban / urban parts of the region because now you also find an optometrist and audiologist at a rural hospital which was usually not the case before …’, (Graduate, 31 years, Female, Hospital A)

‘… Umthombo (UYDF) has afforded me an opportunity which my family was not able to because I come from a very poor background …, now children in my community will see the importance of education.’ ‘… I have built my mother a house and I now drive …., most people in my community also wish to do the same for their families as well as for themselves’. (Graduate, 35 years, Male, Hospital A)

‘… Umthombo (UYDF) should go out there into schools and make the staff and students know the services they provide, what programmes they sponsor, all that information is not readily available …’ (Graduate, 29 years, Female, Hospital A)

3. Difficult Workplace Environment

‘… as much we want to stay long in our rural hospitals, but we sometimes feel that we are not appreciated if you look at the type of accommodation that is available within the hospital’ … … it is difficult to work in a place where you are not appreciated’. (Graduate, 25 years, Female, Hospital B)

‘…. the rural community also deserves better and quality health care, as this is stipulated by the constitution of South Africa’ …. sometimes there are essential posts that are not available at district hospital ….’ ‘In my first year at work I had to work the whole year without proper equipment … this affected the provision of quality services as I had to compromise a lot’ (Graduate, 30 years, Female, Hospital B)

‘The accessibility of health care facilities in rural areas still remains (a problem), there is not much of choice in relation to health care facilities and if they are there, they are isolated ….’ (Graduate, 28 years, Female, Hospital C)

‘Transport – the availability of transport is a major challenge in our area, the roads are terrible and sometimes not usable ….’ (Graduate, 26 years, Female, Hospital B)

Main Themes & Sub-Themes

Quotes from IDI’s

1. Awareness of UYDF Services

“We were told by UYDF staff that there is a MoU between the department and them (UYDF), but no one has ever explained these agreements to us as the hospitals, and we always get graduates allocated to our hospital by the province ….”. (HRM, DC A, 41 years, Female)

“If the province can give details on the graduates they are allocating to us, if we knew they were from UYDF, that will help us allocate their duties, and let the UYDF Graduates do more of the outreach programmes because of their local knowledge of the area and community”. (Assistant Director, DC B, 3 years, Female)

2. Addressing shortage changes due to the UYDF programme

“When I started here there was only one doctor and one clinical associate with 6 wards to be covered (Male, Female, Peadiatrics, Maternity, OPD and Casualty). Patients used to go back home untreated, and sometimes the ward rounds would only be done once a week in order to cover all wards and that increased the death rate at our hospital,” (Acting Medical Manager, DC C, 32 years, Male)

“… Our facilities have struggled in the past to train and attract professionals especially health care professionals, due to the lack of funding and the geographical location …” (HRM/Acting CEO, DC C, 51 years, Male)

“… Majority of the healthcare professionals at our institution are there through UYDF. They are long-term staff that bring stability”. (CEO, DC C, 50 years, Male)

3. Retention

“… UYDF assists with our staff retention strategy as the students work in their rural communities after completion of their studies, and the majority of them stay longer than their contracts ….”. (Medical Manager, DC B, 39 years, Female)

“…. Even those who came to our facilities, we are unable to retain them, they are overworked with no recreational facilities around our hospitals …” (Acting Medical Manager, DC C, 32 years, Male)

1. Better range of services and cutting costs

“…it is no longer necessary for people in the rural areas to have appointments scheduled in the regional or tertiary hospitals…. because patients get a variety of services at the local hospital, such as psychological services, eye care and all rehabilitation services are on site now, which was not the case before…”, (Medical Manager, DC B, 51 years, Male)

2. Improved communication, saving lives

“They are generally local and know the language and situation of the patients”. (Medical Manager, DC B, 39 years, Female)

“Majority of the UYDF graduates had a strong sense of commitment to the rural communities where they work, and they showed responsibility in giving back to their communities of origin ….” (Medical Manager, DC B, 51 years, Male)

“No one wants to see anyone die, and an idea that fights mortality is always a good idea which needs to be supported. This is exactly what the UYDF is doing for our institution – it prevents deaths of many people”. (Deputy Director, DC C, 36 years, Male)