Retaining Doctors in Rural Bangladesh: A Policy Analysis

Abstract

Background: Retaining doctors in rural areas is a challenge in Bangladesh. In this study, we analyzed three rural retention policies: career development programs, compulsory services, and schools outside major cities – in terms of context, contents, actors, and processes. Methods: Series of group discussions between policy-makers and researchers prompted the selection of policy areas, which were analyzed using the policy triangle framework. We conducted document and literature reviews (1971-2013), key informant interviews (KIIs) with relevant policy elites (n=11), and stakeholder analysis/position-mapping. Results: In policy-1, we found, applicants with relevant expertise were not leveraged in recruitment, promotions were often late and contingent on post-graduation. Career tracks were porous and unplanned: people without necessary expertise or experience were deployed to high positions by lateral migration from unrelated career tracks or ministries, as opposed to vertical promotion. Promotions were often politically motivated. In policy-2, females were not ensured to stay with their spouse in rural areas, health bureaucrats working at district and sub-district levels relaxed their monitoring for personal gain or political pressure. Impractical rural posts were allegedly created to graft money from applicants in exchange for recruitment assurance. Compulsory service was often waived for political affiliates. In policy-3, we found an absence of clear policy documents obligating establishment of medical colleges in rural areas. These were established based on political consideration (public sector) or profit motives (private sector). Conclusion: Four cross-cutting themes were identified: lack of proper systems or policies, vested interest or corruption, undue political influence, and imbalanced power and position of some stakeholders. Based on findings, we recommend, in policy-1, applicants with relevant expertise to be recruited; recruitment should be quick, customized, and transparent; career tracks (General Health Service, Medical Teaching, Health Administration) must be clearly defined, distinct, and respected. In policy-2, facilities must be ensured prior to postings, female doctors should be prioritized to stay with the spouse, field bureaucrats should receive non-practising allowance in exchange of strict monitoring, and no political interference in compulsory service is assured. In policy-3, specific policy guidelines should be developed to establish rural medical colleges. Political commitment is a key to rural retention of doctors.

Health systems trust in the time of Covid-19 pandemic in Bangladesh: A qualitative exploration

“…A policy analysis on the human resources for health in Bangladesh also revealed that the DGHS is principally managed by the clinicians at the expense of public health experts. At the MoHFW level, the top health-bureaucrats are mostly drawn from other ministries, often unrelated to the health sector 26 . Another theme that emerged as the determinant of health system trust was leadership, both in the health system and the political sphere.…”

Maternal Health Care in Cox’s Bazar, Bangladesh: A Survey of Midwifery Experience at Hope Foundation and a Review of the Literature

“…In addition to these barriers that healthcare providers face, rural patients en-Open Journal of Obstetrics and Gynecology counter significant barriers in accessing those providers. While nearly 70% of the population in Bangladesh lives in rural areas, less than 20% of healthcare workers provide medical care in these areas [20]. This leaves patients turning to untrained providers and a substantial burden being placed on providers practicing in these areas.…”

Doctor Retention in Ireland - What It May Mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

“…1 This research not only helps understand the healthcare personnel challenges in Ireland but also provides an alternative viewpoint through which to understand how the prevailing global healthcare worker crisis is unfolding, and implications that this has for healthcare worker motivation and retention in healthcare human resources systems in developed, mostly the Organisation for Economic Co-operation and Development (OECD), and developing countries, mainly in sub-Saharan Africa and South East Asia. [2][3][4][5][6] This article is also an important addition to the discussion about healthcare worker migration and what the failure to retain medical graduates in some first-world countries such as Ireland may mean in the endeavour to uphold principles set by the World Health Organization (WHO) Global Code on International Recruitment of Health Personnel. 7,8 Further, and most importantly, this article contributes to the understanding of what the challenge of healthcare graduates' migration may mean to the formulation, implementation and evaluation of retention strategies towards the realisation of HRH policy outcomes outlined by the 2018 Astana Declaration, and the HRH Global Strategy (Workforce 2030).…”

“…Rather globalisation, less favourable working conditions in the least developed parts of the world, health worker shortages in the face of increased demand for healthcare specialists mainly as a result of more favourable socio-demographic outcomes amongst the population in the more developed parts of the world and the portable nature of medical qualifications makes the migration of early-career medical doctors inevitable. [1][2][3][4][5] My point in this is that healthcare personnel shortages and the failure to retain young medical doctors in any one country in the developed world is one driver of doctor migration from the already fragile healthcare worker systems in the third world. This pattern of health personnel migration has a less favourable effect on the global health personnel strengthening agenda, and indeed the pursuit of universal health coverage at a world level.…”

“…This is mainly a result financial incapacity which makes it difficult for health systems in these low-income parts of the world to recruit, adequately remunerate and sustain the required number of skilled medical workers. [4][5][6] Health financial challenges for Ireland might not be at the same level as those of the developing world but the health personnel retention and migration challenges appear to be similar. The migration plans of emerging medical doctors in Ireland may mean that there is a possibility that the country may fail to ensure the availability of adequately trained and motivated medical specialist personnel.…”