Interventions for improved retention of skilled health workers in rural and remote areas

Behera, Manas Ranjan; Prutipinyo, Chardsumon; Sirichotiratana, Nithat; Viwatwongkasem, Chukiat

doi:10.4103/1755-6783.205591

Cited by 10 publications

(9 citation statements)

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“…Here, we highlight literature addressing some interventions on workforce supply, distribution, and performance. Most evidence on “workforce plus” interventions (addressing workforce and at least one other building block) is focused on bundled retention packages for health staff in underserved areas—where outcomes assessed are usually staff attrition rates . These interventions usually combine educational, regulatory (governance), and financial incentive design changes as well as good information systems.…”

Section: State Of the Evidencementioning

confidence: 99%

“…• Most evidence on "workforce plus" interventions (addressing workforce and at least one other building block) is focused on bundled retention packages for health staff in underserved areas-where outcomes assessed are usually staff attrition rates. 18,19 These interventions usually combine educational, regulatory (governance), and financial incentive design changes as well as good information systems. Evidence of effects on retention is mixed-short-range evaluation of the Zambian Health Worker Retention Scheme showed positive effects, 20 but a longer-range piece across workforce cadres did not support these findings.…”

Section: Workforcementioning

confidence: 99%

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Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Witter

Palmer

Balabanova

et al. 2019

Health Planning & Management

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Summary Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a “strong health system.” We highlight that current findings on “what works” are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.

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Section: State Of the Evidencementioning

confidence: 99%

Section: Workforcementioning

confidence: 99%

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Witter

Palmer

Balabanova

et al. 2019

Health Planning & Management

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“…Being enrolled in special track, comprising rural recruitment, rural medical school, rural clerkship, scholarship tie to compulsory service was associated with rural preference [ 25 , 26 ] c) Curricula that reflect rural health issues † Curricula designed for rural- or community-based comprising: additional or extended exposures to community or rural settings Curricula designed for rural- or community-based medical education—whether combined with other educational interventions such as scholarships [ 66 ], spending part of medical school in rural locations [ 62 – 65 ], or as a stand-alone intervention [ 30 ]—was associated with better doctor supply in rural areas A fellowship program in a rural hospital, contains a community-based project work, exposures to cases in a rural (secondary hospital), has improved positive attitude toward rural career [ 67 ] d) Continuous professional development for rural health workers † Professional development refers to activities to improve skills and knowledge of health workers including short-term and long-term trainings, postgraduate study and specialization Doctors in rural locations are less likely to have opportunities for postgraduate training compared to those in urban locations [ 68 ]. Evidence indicates that guaranteed professional development (i.e., continuing education, a higher score for postgraduate enrollment) was related to doctors’ rural work [ 50 , 60 , 66 , 69 – 71 ] or staying in rural locations [ 53 , 72 ] Opportunities for professional development, whether of short duration like workshops or longer duration like postgraduate study, is one of the pivotal attributes considered by doctors in deciding to work [ 54 , 56 , 58 , 60 , 73 , 74 ] or stay working [ 16 , 50 ] in rural or remote locations Medical students are more likely to prefer rural posts if being offered opportunities to continue education or enhance their professional development [ 47 , 59 , 75 – 79 …”

Section: Resultsmentioning

confidence: 99%

Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review

et al. 2020

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Background More than 60% of the world’s rural population live in the Asia-Pacific region. Of these, more than 90% reside in low- and middle-income countries (LMICs). Asia-Pacific LMICs rural populations are more impoverished and have poorer access to medical care, placing them at greater risk of poor health outcomes. Understanding factors associated with doctors working in rural areas is imperative in identifying effective strategies to improve rural medical workforce supply in Asia-Pacific LMICs. Method We performed a scoping review of peer-reviewed and grey literature from Asia-Pacific LMICs (1999 to 2019), searching major online databases and web-based resources. The literature was synthesized based on the World Health Organization Global Policy Recommendation categories for increasing access to rural health workers. Result Seventy-one articles from 12 LMICs were included. Most were about educational factors (82%), followed by personal and professional support (57%), financial incentives (45%), regulatory (20%), and health systems (13%). Rural background showed strong association with both rural preference and actual work in most studies. There was a paucity in literature on the effect of rural pathway in medical education such as rural-oriented curricula, rural clerkships and internship; however, when combined with other educational and regulatory interventions, they were effective. An additional area, atop of the WHO categories was identified, relating to health system factors, such as governance, health service organization and financing. Studies generally were of low quality—frequently overlooking potential confounding variables, such as respondents’ demographic characteristics and career stage—and 39% did not clearly define ‘rural’. Conclusion This review is consistent with, and extends, most of the existing evidence on effective strategies to recruit and retain rural doctors while specifically informing the range of evidence within the Asia-Pacific LMIC context. Evidence, though confined to 12 countries, is drawn from 20 years’ research about a wide range of factors that can be targeted to strengthen strategies to increase rural medical workforce supply in Asia-Pacific LMICs. Multi-faceted approaches were evident, including selecting more students into medical school with a rural background, increasing public-funded universities, in combination with rural-focused education and rural scholarships, workplace and rural living support and ensuring an appropriately financed rural health system. The review identifies the need for more studies in a broader range of Asia-Pacific countries, which expand on all strategy areas, define rural clearly, use multivariate analyses, and test how various strategies relate to doctor’s career stages.

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“…The World Health Organization (WHO) describes human resources as an important 'building block in a health systems framework' 1 .Despite this, human resources remain a neglected issues of health systems as a result WHO reported only 38% of global physician workforce and 25% of the nursing workforce serve about over half of the world's population that reside in rural areas. Such disparity in nursing workforce distribution leads to poor health outcomes and increase the global burden of disease 8 .…”

Section: Introductionmentioning

confidence: 99%

Examining the relationship between living conditions, work environment and intent to stay among nurses in current posts in rural areas of Odisha state, India

Behera

Prutipinyo

2020

Bangladesh J Med Sci

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Objectives : The scarcity of nursing workforce in rural and underserved areas are key challenges for healthcare systems across the countries. Such inequities have not only impede quality care but also an impact to population health outcomes especially in developing countries. An understanding about nurses’ retention and attrition are crucial to inform policy and decision makers for improved rural retention among nursing workforce. The aim of the study was to examine the relationship between living conditions, work environment and intent to stay in current posts of work; and the associated factors influencing intent to stay in current posts of work among nurses in rural areas of Odisha state, India. Methods : A cross sectional survey was conducted among 232 nurses from October 2016 to February 2017. Multistage sampling technique was used to select the study subjects from rural hospitals. Data were collected using structured self-administered questionnaires. Descriptive statistics were computed to summarize the basic characteristics of study sample. Logistic regression model was fitted and odds ratio with 95% of confidence interval was calculated to identify associated factors Results: The proportion of a nurse’s intent to stay and continue working in rural areas for next 3 years was 73.7%. There was a positive correlation between intention to stay with the living conditions and work environment. Logistic regression shown that age (OR=0.95, 95% CI = 0.89 - 0.98, P = 0.047), living conditions (OR = 1.13, 95% CI = 1.04 - 1.22, P=0.009) and work environment (OR = 1.07, 95% CI = 1.01 – 1.14, P = 0.015) were the significant predictors that are associated with intent to stay in rural areas among the nursing profession. Conclusion - Improving living conditions and creating a culture of supportive work environment among the nursing community in rural areas can create increased retention in the workforce. Bangladesh Journal of Medical Science Vol.19(3) 2020 p.527-536

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Interventions for improved retention of skilled health workers in rural and remote areas

Cited by 10 publications

References 0 publications

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review

Examining the relationship between living conditions, work environment and intent to stay among nurses in current posts in rural areas of Odisha state, India

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