Like sub-Saharan African countries, Uganda's 29 million people face huge health challenges, including HIV, malaria, TB, maternal mortality (880 per 100,000 live births) and child mortality (79 per 1000 live births) . Uganda spends about 1.3 percent of its gross national product on health, or about $23 per person per year. We conducted a study of nursing student career intentions in Uganda to gain an understanding of factors that could encourage nurses to practice in settings where they would most contribute to addressing this country's large health challenges.
Regardless of the ratio of nurses to the population, most countries around the world have declared themselves to be in need of additional nurses. Among those claiming a shortage is the United States (U.S.), which has 773 nurses to 100,000 population, and Uganda, with a dismal six nurses to 100,000 population . Nurses in low-income countries are migrating to wealthier countries in search of better salaries, improved working conditions, and more opportunities for further training, resulting in a "brain drain." The predicted additional nurse requirements of the developed world are large enough to deplete the supply of qualified nurses throughout the developing world .
There is an established connection between adequate health worker staffing levels and positive care outcomes. The Joint Learning Initiative examined various measures of health care outcomes in countries around the globe, compared those outcomes to the number of health workers in the population, and determined that countries need at least 2.5 health workers per thousand population to achieve minimal health care coverage . Sub-Saharan Africa needs 600,000 additional nurses to meet the average density for low-income countries, a goal unlikely to be achieved with the continued exodus of nurses from African countries . Africa, with 24 percent of the global burden of disease, employs only three percent of all health professionals . Nurses in Africa are arguably the most important health care workers available in most sub-Saharan nations, as they perform a broad range of tasks and are often working in settings where no other health workers, including physicians, are available . Further exacerbating health disparities, African health professionals, not unlike their counterparts worldwide, prefer to work in urban areas over rural areas .
While there have been numerous studies on the exodus of nurses from Africa, these studies have primarily focused on the views of and the push/pull factors affecting nurses already in practice. Push factors for health workers include poor remuneration and conditions of service, civil unrest, lack of opportunities for postgraduate training, feelings of lack of respect/value placed in health workers by country/system, and concern about poor governance and management of the health system [3, 8–14]. Pull factors include opportunities for further training and career advancement, greater financial rewards and improved working conditions, availability of posts, job security and job satisfaction [3, 9, 11–14]. In addition, factors such as loyalty to country, sense of professional and pride, and expectations of depression have been mentioned in literature, but not yet studied . There has not yet been a published study that elucidates nursing students' intentions and perceptions of emigration while they are still pursuing their educational training. Exploring students' conceptions allows a fresh plane of analysis and a new avenue of possible interventions to this problem. Information on the views of the next generation of nursing professionals can help shape policy at training institutions as well as at the governmental level.
This paper was intended to explore students' views on the factors that will influence their future practice locations, along three dimensions: rural/urban; public/private; and in Uganda, another African country or abroad. We created a conceptual framework illustrating the profiles of qualities associated with various practice preferences, based on our findings. This contribution to the literature is made in the interest of informing school admissions policies, scholarship policies, and approaches to training.