A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries

Abstract

Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem.Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period.Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type.Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of “grow your own” strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.

Training for Transformation: Opportunities and Challenges for Health Workforce Sustainability in Developing a Remote Clinical Training Platform

“…Whether these initiatives are indeed sufficient to ensure sustainability of the newly developed site will need to be confirmed in follow up studies. However, there is no doubt that sustainability is a critical element in the successful implementation of rural pathways to train, develop and support health workers in LMICs (12), of which the Upington clinical training site represents an example.…”

“…Considerable differences in the healthcare climates between HICs and LMICs could plausibly impact the efficacy of rural training pathway strategies across these contexts. If LMICs are going to use undergraduate rural clinical exposure as a strategy for rural pathway development (12), it is critical to understand what the barriers to and facilitators of developing training sites might be. The need to rethink how the future workforce is trained, where they are trained and how to support existing rural health care services is imperative in speaking to the needs of LMICs and countries where disparities in health care provision are significant (2,13), especially because of the complexity involved in implementing such strategies given the demands of competing healthcare priorities (12).…”

A Framework to Guide the Implementation of Best Practice Clinical Learning Environments in Community General Practice: Australia

“…Other research promotes “systems thinking” in health services and development [ 28 ] which is aligned with the approach used in our project. Internationalising frameworks requires testing these in various countries and health systems, which will be an important next step for this project [ 29 ]. However, in the Australian context, the GPCLE Framework complements the BPCLE Framework to provide guidance on implementing high-quality learning environments that are tailored to the clinical setting (hospital or community/general practice).…”

Selection, training and employment to encourage early‐career doctors to pursue a rural postgraduate training pathway

“…The authors independently coded and iteratively discussed emerging themes based on the WHO's rural retention guidelines 9 and rural pathways checklist, 10 as well as Australian evidence about rural medical workforce patterns 11 . To aid interpretation, transcripts and extracted text included notation of participant characteristics such as their career stage and location of work.…”