Career Intentions of Final-Year Health-Professional Students in Lao PDR: A Cross-Sectional Study of Factors Influencing Public-Sector Attraction

BackgroundEnsuring a sufficient and motivated health workforce requires not only retaining existing staff but also understanding the intentions of those entering the labour market. In Lao PDR, limited civil-servant quotas, prolonged volunteer pathways, and expanding private sector opportunities shape the early career choices of health professional students. Yet little is known about how final-year students perceive the public sector or what influences their decision to join or avoid government service. MethodsA cross-sectional survey was conducted among 298 final-year students from four major public health-training institutions. The questionnaire assessed demographic characteristics, motivations for choosing a field of study, post-graduation plans, and perceived drivers and barriers to public-sector employment. Descriptive statistics, chi-square tests, and multivariate logistic regression were used to identify factors independently associated with intention to work in the public sector. ResultsResults: Two thirds of students (66.1%) reported willingness to work in the public sector, though nearly as many simultaneously considered private sector employment (64.8%) and 43.3% expressed interest in working abroad, reflecting a "portfolio approach" to career planning under uncertainty. In multivariate analysis controlling age, field of study, and training institution, several factors independently predicted public sector intention. Each additional year of age increased the odds of public-sector preference by 21% (AOR 1.21, 95% CI 1.07-1.38, p = 0.003). Field of study demonstrated significant variation: pharmacy and dentistry students had 62% lower odds of public-sector intention compared to medical doctors (AOR 0.38, 95% CI 0.15-0.98, p = 0.045), while nursing and midwifery students showed equivalent preference (AOR 0.94, 95% CI 0.46-1.91, p = 0.855). Training institution emerged as a powerful predictor: students from provincial colleges demonstrated nearly three-fold higher odds of public-sector intention compared to those at the University of Health Sciences in Vientiane Capital (AOR 2.80, 95% CI 1.38-5.68, p = 0.004). Gender and marital status, while associated in bivariate analysis, did not remain significant in the adjusted model. ConclusionFinal-year health professional students in Lao PDR demonstrate substantial public-sector commitment, but career intentions are shaped by institutional context and opportunity structures rather than motivation alone. To strengthen workforce recruitment, policymakers should leverage provincial training pipelines, implement field specific retention strategies for high risk disciplines, and ensure equitable career pathways that transform structural barriers into accessible entry mechanisms for all motivated graduates.