Accra – A leading health figure has called for an increase in rural training for medical students, saying the experience resulted in more doctors choosing to practise in rural areas after their graduation."We found that the academic performance of students who trained in decentralised, rural areas was often similar to or better than those not involved in rural training."The experience also led to improved practical skills, higher confidence levels and better workforce retention of doctors in rural areas, which is critical considering our resource constraints," says Stellenbosch University’s Professor Marietjie de Villiers who is also vice chair of the African Forum for Research and Education in Health (AFREhealth).Her comments come as South Africa prepares to move the country’s health system to a National Health Insurance plan which involves a more primary healthcare-based approach – less curative and more emphasis on prevention of diseases at community level.Stellenbosch University is the first university on the African continent to have piloted a unique programme which sends final year medical students to train in rural areas – a project which has since also been successfully rolled out by the University of KwaZulu-Natal.The training of medical students at rural sites is being mooted as a way to address the critical shortage of doctors in rural areas as many opt for the private sector after graduation – or are lost to foreign markets which offer more lucrative opportunities. Many cite poor conditions and the lack of resources as the biggest turnoffs in working in rural areas.Falling short of averageAddressing delegates at a conference in Ghana this week, De Villiers says rural training must ensure key elements are in place to ensure its success and encourage retention of doctors. These include adequate infrastructure in rural areas, proper learning resources – online and on-site, motivated supervisors, strong community partnerships and proper accommodation."Medical students need more exposure to a rural context for them to appreciate its value. They cannot do this by spending just one or two weeks. Their placement must be done for at least six months to a year so that they really immerse themselves in community health issues at that level."But we must also ensure that they have all the support needed to make it work, otherwise they will not want to return as graduate doctors," said De Villiers.South Africa currently has 25 state doctors for every 100 000 citizens, falling short of the average of 60 per 100 000. The country also lags behind India which boasts 70 doctors per 100 000 people and Brazil which has 189 per 100 000.Latest reports also show that South African graduate doctors continue to lack confidence in state healthcare facilities, while foreign doctors were more willing to work there.A recent study by Econex showed up to 80% of newly-qualified doctors chose not to work in public health facilities.