Research Article | | Peer-Reviewed

Push or Pull Factors: Willingness of Medical Students to Work in Rural Areas

Received: 18 December 2025     Accepted: 21 January 2026     Published: 9 February 2026
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Abstract

Introduction: Healthcare service delivery in India is not possible without strengthening the primary healthcare system. Most of the Indian states struggle with the medical workforce especially doctors at Primary Health Centers (PHCs). Chhattisgarh being tribal state with mostly rural area is not an exception. It’s not easy to retain doctors at PHCs unless there is systematic investment in understanding their plans for career, preferences for medical specialization, desired location to serve and overall approach to work in rural and remote areas. This study attempts to explore the various factors during academic tenure which influence medical students to make decisions about working in rural areas through public health service. Methodology: A cross-sectional survey was conducted in all the six government medical colleges in the state of Chhattisgarh. Data was collected from 1917 students admitted in last 5 years in all 6 Government Medical colleges. Study was conducted using a self-administered semi structured questionnaire. Data was analyzed using SPSS version 20. Results: Of 1,917 respondents, 50.9% were female. Overall, 38.1% expressed willingness to serve in rural areas. Gender, social category, residential background, and academic year significantly influenced willingness (p < 0.05). Students from tribal backgrounds (AOR=2.84; 95% CI: 2.10–3.84), rural upbringing (AOR=2.17; 95% CI: 1.58–2.99), and first/second-year students (AOR=1.92; 95% CI: 1.33–2.78) showed higher inclination. Motivational factors included better housing, incentives, and exposure to rural health facilities. Nearly 90.8% preferred post graduation immediately after MBBS, regardless of background. Conclusion: The Indian public sector has introduced a range of financial and non-financial incentives to encourage health workers, particularly allopathic doctors, to serve in rural areas. However, most existing strategies address isolated challenges or are implemented only after the completion of medical training. Our findings suggest the need to move away from this fragmented incentive model towards a comprehensive ‘package’ approach that creates a supportive and enabling environment during the MBBS period itself, thereby shaping career choices early on. Only through such an approach can government service and rural postings become genuinely attractive options for health professionals.

Published in Central African Journal of Public Health (Volume 12, Issue 1)
DOI 10.11648/j.cajph.20261201.12
Page(s) 11-18
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Career Choice, Health Workforce, Medical Students, Public Sector, Rural Health

References
[1] Indian Public Health Standards for PHC, National Health Mission, Government of India, Available at
[2] Update on Ratio Of Patients And Doctors Nurses, Ministry of Health & Family Welfare, Press Information Bureau Available at
[3] Rural Health Statistics, Government of India, Ministry of Health & Family Welfare, National Rural Health Mission (NRHM): Available at
[4] Nallala S, Swain S, Das S, Kasam SK, Pati S. Why medical students do not like to join rural health service? An exploratory study in India. Journal of family and community Medicine. 2015 May 1; 22(2): 111-7.
[5] Agyei-Baffour, P., Kotha, S. R., Johnson, J. C. et al. Willingness to work in rural areas and the role of intrinsic versus extrinsic professional motivations - a survey of medical students in Ghana. BMC Med Educ 11, 56 (2011).
[6] Getachew B, Bizuneh B, Ewunetu B, Kassahun D, Fentahun D, Ademe D, Cherkos EA, Kebede AA. Willingness to work in rural areas and associated factors among graduating health students at the University of Gondar, northwest Ethiopia, 2021. PLoS One. 2022 Oct 21; 17(10): e0276594.
[7] Bao, M., Huang, C. Job preferences of medical and nursing students seeking employment in rural China: a discrete choice experiment. BMC Med Educ 21, 146 (2021).
[8] Budhathoki SS, Zwanikken PA, Pokharel PK, Scherpbier AJ. Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review. BMJ Open. 2017 Feb 22; 7(2): e013501.
[9] Goel S, Angeli F, Dhirar N, Sangwan G, Thakur K, Ruwaard D (2019) Factors affecting medical students’ interests in working in rural areas in North India—A qualitative inquiry. PLoS ONE 14(1): e0210251.
[10] Kuteesa J, Musiime V, Munabi IG, Mubuuke AG, Opoka R, Mukunya D, Kiguli S. Specialty Career Preferences among Final Year Medical Students at the School of Medicine, Makerere University College of Health Sciences, Uganda. Research Square. 2020 Jun 29: 1.
[11] Royston PJ, Mathieson K, Leafman J, Ojan-Sheehan O. Medical student characteristics predictive of intent for rural practice. Rural and Remote Health. 2012 Sep; 12(3): 1-0.
[12] Jose, Maria & Obse, Amarech & Zuidgeest, Mark & Alaba, Funke. (2020). Preferences of Medical Students for Rural Medical Internships in South Africa: A Discrete Choice Experiment.
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  • APA Style

    Singh, G. (2026). Push or Pull Factors: Willingness of Medical Students to Work in Rural Areas. Central African Journal of Public Health, 12(1), 11-18. https://doi.org/10.11648/j.cajph.20261201.12

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    ACS Style

    Singh, G. Push or Pull Factors: Willingness of Medical Students to Work in Rural Areas. Cent. Afr. J. Public Health 2026, 12(1), 11-18. doi: 10.11648/j.cajph.20261201.12

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    AMA Style

    Singh G. Push or Pull Factors: Willingness of Medical Students to Work in Rural Areas. Cent Afr J Public Health. 2026;12(1):11-18. doi: 10.11648/j.cajph.20261201.12

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  • @article{10.11648/j.cajph.20261201.12,
      author = {Gajendra Singh},
      title = {Push or Pull Factors: Willingness of Medical Students to Work in Rural Areas},
      journal = {Central African Journal of Public Health},
      volume = {12},
      number = {1},
      pages = {11-18},
      doi = {10.11648/j.cajph.20261201.12},
      url = {https://doi.org/10.11648/j.cajph.20261201.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20261201.12},
      abstract = {Introduction: Healthcare service delivery in India is not possible without strengthening the primary healthcare system. Most of the Indian states struggle with the medical workforce especially doctors at Primary Health Centers (PHCs). Chhattisgarh being tribal state with mostly rural area is not an exception. It’s not easy to retain doctors at PHCs unless there is systematic investment in understanding their plans for career, preferences for medical specialization, desired location to serve and overall approach to work in rural and remote areas. This study attempts to explore the various factors during academic tenure which influence medical students to make decisions about working in rural areas through public health service. Methodology: A cross-sectional survey was conducted in all the six government medical colleges in the state of Chhattisgarh. Data was collected from 1917 students admitted in last 5 years in all 6 Government Medical colleges. Study was conducted using a self-administered semi structured questionnaire. Data was analyzed using SPSS version 20. Results: Of 1,917 respondents, 50.9% were female. Overall, 38.1% expressed willingness to serve in rural areas. Gender, social category, residential background, and academic year significantly influenced willingness (p < 0.05). Students from tribal backgrounds (AOR=2.84; 95% CI: 2.10–3.84), rural upbringing (AOR=2.17; 95% CI: 1.58–2.99), and first/second-year students (AOR=1.92; 95% CI: 1.33–2.78) showed higher inclination. Motivational factors included better housing, incentives, and exposure to rural health facilities. Nearly 90.8% preferred post graduation immediately after MBBS, regardless of background. Conclusion: The Indian public sector has introduced a range of financial and non-financial incentives to encourage health workers, particularly allopathic doctors, to serve in rural areas. However, most existing strategies address isolated challenges or are implemented only after the completion of medical training. Our findings suggest the need to move away from this fragmented incentive model towards a comprehensive ‘package’ approach that creates a supportive and enabling environment during the MBBS period itself, thereby shaping career choices early on. Only through such an approach can government service and rural postings become genuinely attractive options for health professionals.},
     year = {2026}
    }
    

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  • TY  - JOUR
    T1  - Push or Pull Factors: Willingness of Medical Students to Work in Rural Areas
    AU  - Gajendra Singh
    Y1  - 2026/02/09
    PY  - 2026
    N1  - https://doi.org/10.11648/j.cajph.20261201.12
    DO  - 10.11648/j.cajph.20261201.12
    T2  - Central African Journal of Public Health
    JF  - Central African Journal of Public Health
    JO  - Central African Journal of Public Health
    SP  - 11
    EP  - 18
    PB  - Science Publishing Group
    SN  - 2575-5781
    UR  - https://doi.org/10.11648/j.cajph.20261201.12
    AB  - Introduction: Healthcare service delivery in India is not possible without strengthening the primary healthcare system. Most of the Indian states struggle with the medical workforce especially doctors at Primary Health Centers (PHCs). Chhattisgarh being tribal state with mostly rural area is not an exception. It’s not easy to retain doctors at PHCs unless there is systematic investment in understanding their plans for career, preferences for medical specialization, desired location to serve and overall approach to work in rural and remote areas. This study attempts to explore the various factors during academic tenure which influence medical students to make decisions about working in rural areas through public health service. Methodology: A cross-sectional survey was conducted in all the six government medical colleges in the state of Chhattisgarh. Data was collected from 1917 students admitted in last 5 years in all 6 Government Medical colleges. Study was conducted using a self-administered semi structured questionnaire. Data was analyzed using SPSS version 20. Results: Of 1,917 respondents, 50.9% were female. Overall, 38.1% expressed willingness to serve in rural areas. Gender, social category, residential background, and academic year significantly influenced willingness (p < 0.05). Students from tribal backgrounds (AOR=2.84; 95% CI: 2.10–3.84), rural upbringing (AOR=2.17; 95% CI: 1.58–2.99), and first/second-year students (AOR=1.92; 95% CI: 1.33–2.78) showed higher inclination. Motivational factors included better housing, incentives, and exposure to rural health facilities. Nearly 90.8% preferred post graduation immediately after MBBS, regardless of background. Conclusion: The Indian public sector has introduced a range of financial and non-financial incentives to encourage health workers, particularly allopathic doctors, to serve in rural areas. However, most existing strategies address isolated challenges or are implemented only after the completion of medical training. Our findings suggest the need to move away from this fragmented incentive model towards a comprehensive ‘package’ approach that creates a supportive and enabling environment during the MBBS period itself, thereby shaping career choices early on. Only through such an approach can government service and rural postings become genuinely attractive options for health professionals.
    VL  - 12
    IS  - 1
    ER  - 

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