 This study examined the factors that influenced the decision of clinical officers, COs, to remain in rural district hospital, DH, posts after graduating from a bachelors of science, BSc, in surgery program. The results showed that the most common barrier to staying in a DH post was a lack of promotion opportunities, while the most common enabler was a willingness to accept a lower salary than what they could obtain elsewhere. Additionally, the COs reported that the hope of being promoted within the government system, and the opportunity to generate additional income through private practice, also played a role in their decision to remain in a DH post. These findings suggest that there needs to be a comprehensive strategy to retain COs in rural DHs, including providing clear career paths and promoting COs within the government system. This article was authored by Jakub Gajuski, Marisa Wallace, Kara Petalis and others.