Building the healthcare capacity in rural Native Hawaiian communities: Evaluation of a values-based health scholarship program

Introduction. A shortage of Native Hawaiian healthcare professionals exists in Hawai`i medically underserved communities. Contributing to this shortage is the disproportionately low enrollment of Native Hawaiians in primary healthcare education. The Native Hawaiian Health Scholarship Program (NHHSP) of Papa Ola Lokahi addresses the shortage by providing scholarships to Native Hawaiians in designated healthcare professionals and then facilitating their employment in Hawai`i underserved communities to perform their service obligation.

Methods. The NHHSP uses a values-based assessment to select scholarship awardees. We surveyed all 104 scholars who were performing or had completed their service obligation by May 2006. The 54 returned surveys were analyzed to see if scholars for whom Hawaiian values were more important made greater contributions in their rural sites.

Conclusion. NHHSP scholars are making significant contributions to develop the capacity of community healthcare systems. Seventy-three percent of clinicians who completed their service remained in their rural sites an average of 2.8 years, exceeding the retention rate for National Health Service Corps scholarship and loan repayment programs. Respondents held significant leadership roles and active memberships in Native Hawaiian communities, and 85% developed 3 to 4 Native Hawaiian community programs during service. Those rating themselves higher on the community-identified values held more leadership positions and had helped develop behavioral and cultural programs in their sites. To our knowledge, this innovative study is the first to understand how community-identified values of healthcare providers contribute to capacity-building efforts in underserved communities. Innovative ways to address retention of providers in rural areas is warranted.