Background: In order to improve health in low- and middle- income countries the basic health infrastructure needs to be upgraded. Part of the problem is the shortage of skilled healthcare professionals (HCP) particularly in rural areas. The Umthombo Youth Development Foundation (UYDF) is a non-profit organisation (NPO) established in 1999 to assist in addressing shortage of HCPs in rural areas. The aim of this study is to measure the success of the UYDF bursary scheme in achieving this goal by calculating the cost of supporting rural students and estimating the benefits in relieving the shortage in terms of the financial return on investment.Methods: The sources of the data were the UYDF organisational records (finance, human resources and procurement), supplemented by the published and unpublished UYDF reports.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 UYDF database of beneficiaries showed that by the year 2017 a total of 337 HCPs had graduated and a further 254 were still studying. An average of R17 million was spent every year on the students or R102 015 per student per year. The IRR was 63% higher than interest rates on commercial loans. These graduates are expected to generate an estimated R15 billion in lifetime earnings, which would be equal to R4 billion at current prices.Conclusion: The UYDF scheme relieved the shortage of HCPs in rural hospitals, and the hospitals were able to retain the service of many of the locally sourced HCPs. The costs of implementing the bursary scheme were outweighed by the income generated from salaries, and taxes contributed to the country’s economic development.

There has been a shift during the past 60 years from a broad notion of the entire nation as underserved to a more focused effort to identify particular areas (often rural) thought to be underserved. This approach was formalized with the advent of the war on poverty. This focused approach has been cemented during the past 30 years, in part by the success of various federal health center programs that have remained funded during this period in spite of opposition. This paper concludes that the consensus view that rural underserved areas represent an "exception" phenomenon that is properly addressed with special responses (organizations or physicians) has had two major effects: (1) the political survivability of focused programmatic responses (such as Community Health Centers) has been enhanced; and (2) the existence of an "elastic net" policy network to advocate for the expansion of such remedial efforts may play a contributory role in helping to defeat comprehensive health reform.

Background In order to improve health in low- and middle- income countries the basic health infrastructure needs to be upgraded. Part of the problem is the shortage of skilled healthcare professionals (HCP) particularly in rural areas. The Umthombo Youth Development Foundation (UYDF) is a non-profit organisation (NPO) established in 1999 to assist in addressing shortage of HCPs in rural areas. The aim of this study is to measure the success of the UYDF bursary scheme in achieving this goal by calculating the cost of supporting rural students and estimating the benefits in relieving the shortage in terms of the financial return on investment.Methods The sources of the 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 UYDF database of beneficiaries showed that by the year 2017 a total of 337 HCPs had graduated and a further 254 were still studying. An average of R17 million was spent every year on the students or R102 015 per student per year. The IRR was 63% higher than interest rates on commercial loans. These graduates are expected to generate an estimated R15 billion in lifetime earnings, which would be equal to R4 billion at current prices.Conclusion The UYDF scheme relieved the shortage of HCPs in rural hospitals, and the hospitals were able to retain the service of many of the locally sourced HCPs. The costs of implementing the bursary scheme were outweighed by the income generated from salaries, and taxes contributed to the country’s economic development.