Increasing access to health workers in remote and rural areas through improved retention
Global Policy Recommendations
World Health Organization - July 2010 ISBN: 9789241564014
Available online PDF [79p.] at: http://bit.ly/bw3qy9
Globally, approximately one half of the population lives in rural areas, but less than 38% of the nurses and less than 25% of the physicians work there. While getting and keeping health workers in rural and remote areas is a challenge for all countries, the situation is worse in the 57 countries that have an absolute shortage of health workers.
After a year-long consultative effort, this document proposes sixteen evidence-based recommendations on how to improve the recruitment and retention of health workers in underserved areas. It also offers a guide for policy makers to choose the most appropriate interventions, and to implement, monitor and evaluate their impact over time.
Annexes
:: Annex 1 – Grade evidence profiles [pdf 151kb]
:: Annex 2 – Descriptive evidence profiles [pdf 220kb]
Tables of contents
Preface
Contributors and acknowledgments
Executive Summary
1. Introduction
1.1 Rationale 7
1.2 Objective 8
1.3 Target audience 8
1.4 Scope 9
1.4.1 Types of health workers targeted 9
1.4.2 Geographical areas covered 9
1.4.3 Categories of interventions covered 10
1.5 Process for formulating the global recommendations 10
1.6 Dissemination process 11
1.7 Methodology 11
1.8 Structure of the report 11
2. Principles to guide the formulation of national policies to improve retention of health workers in remote and rural areas
2.1 Focus on health equity 13
2.2 Ensure rural retention policies are part of the national health plan 13
2.3 Understand the health workforce 14
2.4 Understand the wider context 14
2.5 Strengthen human resource management systems 15
2.6 Engage with all relevant stakeholders from the beginning of the process 16
2.7 Get into the habit of evaluation and learning 16
3. Evidence-based recommendations to improve attraction, recruitment and retention of health workers in remote and rural areas
3.1 Education 18
3.1.1 Get the “right” students 18
3.1.2 Train students closer to rural communities 19
3.1.3 Bring students to rural communities 21
3.1.4 Match curricula with rural health needs 21
3.1.5 Facilitate professional development 22
3.2 Regulatory interventions 23
3.2.1 Create the conditions for rural health workers to do more 23
3.2.2 Train more health workers faster to meet rural health needs 24
2 3.2.3 Make the most of compulsory service 25
3.2.4 Tie education subsidies to mandatory placements 26
3.3 Financial incentives 27
3.3.1 Make it worthwhile to move to a remote or rural area 28
3.4 Personal and professional support 29
3.4.1 Pay attention to living conditions 30
3.4.2 Ensure the workplace is up to an acceptable standard 31
3.4.3 Foster interaction between urban and rural health workers 31
3.4.4 Design career ladders for rural health workers 32
3.4.5 Facilitate knowledge exchange 33
3.4.6 Raise the profile of rural health workers 34
4. Measuring results: how to select, implement and evaluate rural retention policies
4.1 Relevance: which interventions best respond to national priorities and the expectations of health workers and rural communities? 36
4.2 Acceptability: which interventions are politically acceptable and have the most stakeholder support? 36
4.3 Affordability: which interventions are affordable? 38
4.4 Effectiveness: have complementarities and potential unintended consequences between various interventions been considered? 38
4.5 Impact: what indicators will be used to measure impact over time? 39
5. Research gaps and research agenda
5.1 Research gaps 42
5.1.1 Study all types of health workers 42
5.1.2 More research in low-income countries 42
5.1.3 More well-designed evaluations 42
5.1.4 Quality of the evidence – not only “what works”, but also “why” and “how” 42
5.2 Research agenda 43
6. Deciding on the strength of the recommendations 44
Methodology
List of participants
References
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