A qualitative inquiry of rural-urban inequalities in the distribution and retention of healthcare workers in southern Nigeria

Abstract

Introduction Globally, the population in rural communities are disproportionately cared for by only 25% and 38% of the total physicians and nursing staff, respectively; hence, the poor health outcomes in these communities. This condition is worse in Nigeria by the critical shortage of skilled healthcare workforce. This study aimed to explore factors responsible for the uneven distribution of healthcare workers (physicians and nurses) to rural areas of Ebonyi State, Nigeria. Methods Qualitative data were obtained using semi-structured in-depth interviews and focus group discussions from purposively selected physicians, nurses, and policymakers in the state. Data was analysed for themes related to factors influencing the mal-distribution of healthcare workers (physicians and nurses) to rural areas. The qualitative analysis involved the use of both inductive and deductive reasoning in an iterative manner. Results This study showed that there were diverse reasons for the uneven distribution of skilled healthcare workers in Ebonyi State. This was broadly classified into three themes; socio-cultural, healthcare system, and personal healthcare workers’ intrinsic factors. The socio-cultural factors include symbolic capital and stigma while healthcare system and governance issues include poor human resources for health policy and planning, work resources and environment, decentralization, salary differences, skewed distribution of tertiary health facilities to urban area and political interference. The intrinsic healthcare workers’ factors include career progression and prospect, negative effect on family life, personal characteristics and background, isolation, personal perceptions and beliefs. Conclusions There may be a need to implement both non-financial and financial actions to encourage more urban to rural migration of healthcare workers (physicians and nurses) and to provide incentives for the retention of rural-based health workers.

Factors associated with the recruitment and retention of family and community medicine and nursing residents in rural settings: A qualitative study

“…These results are also identi ed in previous studies [13,33]. The feeling of isolation and non-integration are personal factors identi ed in other studies [34], and the results point in that direction since friendships or support networks were identi ed as very important and fundamental for retention. It should be noted that the impact of the COVID-19 pandemic during training in uenced the ability to form bonds [35][36][37].…”

Do health service contacts with community health workers influence the intention to use modern contraceptives among non-users in rural communities? Findings from a cross-sectional study in Nigeria

“…This study examined the extent of the association between health service contacts with CHWs and the intention to use modern contraceptives in settings with limited access to skilled health personnel such as doctors and nurses/midwives. This study builds on existing RC (Reference category), *p < 0.05, **p < 0.01 works that have established the important roles of CHWs in boosting contraceptive prevalence [30][31][32]36] and was carried out to provide more information on an additional initiative that may boost modern contraceptive usage in rural and remote communities of Nigeria in light of the grossly insufficient numbers of skilled health personnel in such communities [19,20], which makes the CHWs an important provider of reproductive health services in such communities [13,23,24]. This presents an opportunity for family planning programmers to leverage the patronage of CHWs for the purpose of family planning demand generation by encouraging CHWs to use every health service contact with the rural populace to talk about family planning, clear family planning misconceptions, and provide enlightened information about the health concerns of family planning usage.…”

“…In spite of the evidence of CHWs relevance to contraceptive usage in the country, studies have rarely examined whether in the absence of skilled health personnel such as doctors and nurses in rural and remote communities, the health service contacts of non-users with CHWs drive the intention to use contraceptives. This is important because, in many rural and remote communities of Nigeria, skilled health personnel is not readily available at health facilities in addition to other sundry challenges such as long distances to the facility, lack of essential drugs, and poverty [ 18 , 20 ]. These challenges discourage the use of essential healthcare services in rural areas.…”

“…The CHWs received limited health-related training certified by the Community Health Practitioners Registration Board of Nigeria. This enables CHWs to provide recognized specific primary health care both in a health facility and as well as in the community [16,17], to support the services provided by skilled health personnel such as doctors and nurses/midwives, who in many instances are not readily available in rural and remote communities [18][19][20]. The range of duties performed by CHWs includes but is not limited to supporting maternal and child health [21][22][23][24], helping to control communicable and non-communicable diseases [25], treatment of endemic diseases [26], promoting adequate nutrition [27], providing support during outbreaks of pandemics [17,28], home visits, referral of patients, and disease surveillance [29].…”

Skilled antenatal care services utilisation in sub-Saharan Africa: a pooled analysis of demographic and health surveys from 32 countries

“…As such, it is very easy for urban dwelling women to have access to ANC services from a skilled provider as compared to those in rural areas. Also, in most cases, skilled providers refuse postings to rural communities; rather, they prefer to be centralised in urban areas where they can have access to various social amenities and socio-economic prospects [ 17 , 18 ]. Thus, limiting the likelihood of rural dwelling women to receive ANC services from skilled providers.…”