Strategies for attraction and retention of health workers in remote and difficult-to-access areas of Chhattisgarh, India: Do they work?

Lisam, Suchitra; Nandi, Sulakshana; Kanungo, Kanica; Verma, Prem; Mishra, Jay Prakash; Mairembam, Dilip Singh

doi:10.4103/0019-557x.164656

Cited by 11 publications

(11 citation statements)

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“…Most commonly reported factors include: inappropriate pre-service training for rural and remote areas practice, lack of prospects for further training and career development, low salaries, poor working environments, limited availability of equipment and drugs, insufficient family support, inadequate management and unsupportive supervision. Although the choice of variables included in this study is guided by the existing literature [34–41], the study could include only a limited number of variables that are available in the DLHS-4 dataset. A detailed description of the variables included in the analysis is given in the table below (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002–2012

Singh¹

2019

BMC Health Serv Res

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Background The onus of providing affordable access to specialist services in rural India primarily lies with publicly funded rural hospitals, also known as community health centres (CHCs). However, no studies have attempted to measure the change in the shortage and distributional inequalities of specialists in the publicly funded rural hospitals of Uttar Pradesh (India). This study attempts to fill that gap. Methods The study uses data from the three latest rounds of the District-Level Household Survey, covering a period of 10 years spanning from 2002 to 2012. Shortages were measured against the Indian Public Health Standards for CHCs, and inequalities were measured using Gini and Theil indices, with the latter decomposed to reveal the source of the inequalities. Negative binomial regression was applied to examine the association between facility characteristics and the availability of specialists in CHCs. Results The current shortage of specialists stands at 80.7% of the total requirement. Currently, 62.1% of CHCs are functioning without a specialist. The distribution of specialists across CHCs has become progressively uneven over the study period, as shown by the rise in the Gini index (from 0.41 in 2002–2004 to 0.74 in 2012–2013). Decomposition analysis reveals that the contribution of within-district inequalities to overall inequality remains high (85.4% of total inequality). About 50% of within-district inequality is contributed by only 20 districts, most of which belong to eastern and central Uttar Pradesh. The analysis of factors affecting the distribution of the current specialist workforce revealed that the number of available specialists at a CHC is positively associated with the availability of residences for doctors and regular electricity supply, and negatively associated with CHC location and the distance of the CHC from the district headquarters. Conclusion The findings suggest that Uttar Pradesh not only needs to recruit more specialists, but it also requires proper implementation of deployment and retention policies to ensure equitable access to specialist care for rural populations. Ensuring the availability of quality accommodations and basic amenities at all CHCs, as well as adequate transport and rural allowance, could help increase the chances of specialists staying in rural and far-off CHCs.

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Section: Methodsmentioning

confidence: 99%

Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002–2012

Singh¹

2019

BMC Health Serv Res

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“…Similar programmes to expand professional training have been conducted in other countries with remote areas. 37 , 38 The need to expand the number of medical courses in Brazil was based on the low supply of undergraduate medical places, which was 0.8 per 10 000 inhabitants in 2011, half that of other countries with universal health systems, such as the United Kingdom of Great Britain and Northern Ireland (1.6 per 10 000 inhabitants). 39 In countries such as Australia, Canada and the United States of America, training programmes to serve populations in remote and rural areas where it was difficult to recruit and retain physicians were implemented in medical schools in the 1960s.…”

Section: Discussionmentioning

confidence: 99%

Implementation research: towards universal health coverage with more doctors in Brazil

Santos

Oliveira

Trindade

et al. 2017

Bull. World Health Organ.

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ObjectiveTo evaluate the implementation of a programme to provide primary care physicians for remote and deprived populations in Brazil.MethodsThe Mais Médicos (More Doctors) programme was launched in July 2013 with public calls to recruit physicians for priority areas. Other strategies were to increase primary care infrastructure investments and to provide more places at medical schools. We conducted a quasi-experimental, before-and-after evaluation of the implementation of the programme in 1708 municipalities with populations living in extreme poverty and in remote border areas. We compared physician density, primary care coverage and avoidable hospitalizations in municipalities enrolled (n = 1450) and not enrolled (n = 258) in the programme. Data extracted from health information systems and Ministry of Health publications were analysed.FindingsBy September 2015, 4917 physicians had been added to the 16 524 physicians already in place in municipalities with remote and deprived populations. The number of municipalities with ≥ 1.0 physician per 1000 inhabitants doubled from 163 in 2013 to 348 in 2015. Primary care coverage in enrolled municipalities (based on 3000 inhabitants per primary care team) increased from 77.9% in 2012 to 86.3% in 2015. Avoidable hospitalizations in enrolled municipalities decreased from 44.9% in 2012 to 41.2% in 2015, but remained unchanged in control municipalities. We also documented higher infrastructure investments in enrolled municipalities and an increase in the number of medical school places over the study period.ConclusionOther countries having shortages of physicians could benefit from the lessons of Brazil’s programme towards achieving universal right to health.

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Section: Discussionmentioning

confidence: 99%

“…In addition, other studies showed that health worker recruitment and retention in rural healthcare facilities could be improved by providing accommodation, special consideration for further studies, financial incentives and providing the necessary work resources (Lisam et al. ; Ojakaa & Jarvis ). In other words, health workers, including nurses, would be more likely to work in rural areas if working conditions were improved.…”

Section: Discussionmentioning

confidence: 99%

“…Some of the factors necessary to retain health workers in rural facilities, especially in developing countries, often focused on an increase in pay, on timely payments and other economic benefits for workers (Lisam et al 2015;Ojakaa & Jarvis 2014;Wurie et al 2016). In addition, other studies showed that health worker recruitment and retention in rural healthcare facilities could be improved by providing accommodation, special consideration for further studies, financial incentives and providing the necessary work resources (Lisam et al 2015;Ojakaa & Jarvis 2014). In other words, health workers, including nurses, would be more likely to work in rural areas if working conditions were improved.…”

Section: Discussionmentioning

confidence: 99%

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Challenges faced in rural hospitals: the experiences of nurse managers in Uganda

Kakyo

Xiao

2018

International Nursing Review

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Strategies for attraction and retention of health workers in remote and difficult-to-access areas of Chhattisgarh, India: Do they work?

Abstract: Establishment of a performance management system, activating the CRMC cell to make it functional, and wide publicity of CRMC benefits are likely to improve attraction and retention of staff.

Cited by 11 publications

References 1 publication

Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002–2012

Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002–2012

Implementation research: towards universal health coverage with more doctors in Brazil

Challenges faced in rural hospitals: the experiences of nurse managers in Uganda

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