Financial incentives for return of service in underserved areas: a systematic review

Abstract

Background: In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future) health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. Methods:We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives). In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation) and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations). We reviewed program results (descriptions of recruitment, retention, and participant satisfaction), program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas), and program impacts (effectiveness in influencing health systems and health outcomes).

Addressing health workforce distribution concerns: a discrete choice experiment to develop rural retention strategies in Cameroon

“…Policy-makers need better evidence to inform context-specific rural retention policies. Interventions to alleviate health worker shortages in medically underserved areas include initiatives such as: i) selective recruitment of individuals into healthcare education who are most likely to work in remote areas, ii) training specifically for serving in remote or challenging geographic zones, iii) improvements in working or living conditions in underserved areas, iv) compulsion, or v) incentives (8). The available evidence shows that wage bonuses, non-financial incentives, regulatory policies such as bonding, and preferential selection of students from rural areas into training programs can work to strengthen retention efforts (9).…”

Retention of doctors in rural health services in Thailand: impact of a national collaborative approach

“…A systematic review of 43 studies including five different types of financial incentive program suggests that participants under the financial incentive programs are more likely than nonparticipants to work in underserved areas in the long run, although they are less likely to remain at the site of original placement 27 . However, most included studies are from Western countries and only few studies from developing countries.…”

Analyzing the Determinants of Health Worker Performance

“…Recent studies have highlighted the importance of providing an appropriate salary to attract health workers to underserved areas (Bärnighausen and Bloom 2009;McCoy et al 2008;Rockers et al 2012;Willis-Shattuck et al 2008). Salary, however, is only one of many factors that health workers consider when making choices about where to work Dambisya 2007;Kruk et al 2010;Rockers et al 2013).…”