Medical and nursing students' intentions to work abroad or in rural areas: An eight-country cross-sectional survey in Asia and Africa

graduates to work in the public sector following graduation. The program currently has a 97% success rate retaining nurses through their service agreement. The objective of this study was to identify job satisfaction and retention factors of scholarship recipients after graduation to evaluate the program, inform stakeholders, and advise future projects. Methods: This was a mixed methods study consisting of qualitative interviews and quantitative surveys that evaluated job satisfaction, factors associated with retention and impact of the GAIA Nursing Scholarship Program. Participants included male and female graduated GAIA scholarship recipients working in the public sector across Malawi, with a representative convenience sample interviewed in person based on employer location. The survey was asked of all program graduates and completed by one-third of this population. We used thematic analysisto analyze qualitative interviews for themes on drivers of public sector retention. Kruskal-Wallis, Pearson correlation and chi-squared tests were used to analyze survey data. Participants signed an informed consent and the study was approved by the Committee on Human Research at the University of California, San Francisco (UCSF) and the College of Medicine Research and Ethics Committee in Malawi. Findings: The study included 30 qualitative interview participants and 56 quantitative survey respondents. The majority of participants indicated they would like to stay in the public sector. Most cited unavailability of supplies, inadequate human resources and high workload as major challenges to their work. Those that indicated poor working relationships with management or coworkers were more likely to consider changing jobs. Low salaries, high workload, poor accommodations provided by public sector workplaces and a lack of appreciation were indicated as reasons nurses choose to leave the public sector. Participants felt supported by GAIA staff and expressed a desire to serve their communities by working in government supported health facilities. Interpretation: There are non-remuneration strategies that low-income countries like Malawi can employ to retain nurses in the public sector. Adequate provision of human and material resources and proper accommodations can greatly improve job satisfaction and retention. Programs such as the GAIA scholarship program may also help increase retention by creating loyalty through careful follow up monitoring. Funding: GAIA, USAID, and UCSF, Department of Global Health Sciences. Abstract #: 01ETC085