Health-care worker retention in post-conflict settings: a systematic literature review

Abstract

Conflicts affect health care systems not only during but also well beyond periods of violence and immediate crises by draining resources, destroying infrastructure, and perpetrating human resource shortages. Improving health care worker retention is critical to limiting the strain placed on health systems already facing infrastructure and financial challenges. We reviewed the evidence on the retention of health care workers in fragile, conflict-affected, and post-conflict settings and evaluated strategies and their likely success in improving retention and reducing attrition. We conducted a systematic review of studies, following PRISMA guidelines. Included studies (1) described a context that is post-conflict, conflict-affected, or was transformed by war or crisis; (2) examined the retention of health care workers; (3) were available in English, Spanish, or French, and (4) were published between 1 January 2000 and 25 April 2021. We identified 410 articles, of which 25 studies, representing 17 countries, met the inclusion criteria. Most of the studies (22 out of 25) used observational study designs and qualitative methods to conduct research. Three studies were literature reviews. This review observed four main themes: migration intention, return migration, work experiences and conditions of service, and deployment policies. Using these themes, we identify a consolidated list of six push and pull factors contributing to health care worker attrition in fragile, conflict-affected, and post-conflict settings. The findings suggest that adopting policies that focus on improving financial incentives, providing professional development opportunities, establishing flexibility, and identifying staff with strong community links may ameliorate workforce attrition.

Oral health system strengthening in fragile and conflict-affected states: A systematic review

“…Conflicts typically deplete a significant portion of a country's resources, placing the health system in competition with other government priorities, notably pronounced in oral health care services, even within the broader health system [41,53]. Furthermore, national health systems often become intentional or unintentional targets during conflicts, compelling health care workers to migrate in disaster situations [65][66][67][68][69]. This phenomenon has been observed in countries like Cambodia, Mozambique, Rwanda, and Haiti, where the already sparse health care workforce has faced casualties and migrations [41][42][43][44].…”

Improvement in nurse staffing ratios according to policy changes: a prospective cohort study

“…If the incentive level is not high, medical institutions may not actively respond to the policy. Second, according to policy experiences and research findings on successful improvements in the nurse staffing levels in other countries, it is challenging to properly increase and sustain nurse staffing in medical institutions in vulnerable regions with only financial incentives [33,34]. Support from the central or local governments is important for improvement in working and living conditions and the working environment, for granting and supporting opportunities for lifelong education, and for offering training and professional development.…”

Strengthening Africa’s Healthcare System: A Multifaceted Approach to Addressing the Nurses and Midwives Shortage

“…This could involve establishing more training facilities and enhancing curricula and faculty, thereby increasing the pool of qualified professionals (15). Implementing retention strategies, such as offering competitive salaries, enhancing working conditions, providing career development opportunities, and creating a supportive work environment, can help keep nurses and midwives in their home countries (16,17). Additionally, focusing on the recruitment and training of healthcare professionals specifically for rural areas can enhance access to healthcare services in underserved regions.…”