Increasing access to health workers in remote and rural areas through improved retention
Global policy recommendations
World Health Organization WHO - 2010 - ISBN: 9789241564014
Available online PDF [80p.] 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….”
Tables of contents
Executive Summary
1. Introduction
1.1 Rationale
1.2 Objective
1.3 Target audience
1.4 Scope
1.4.1 Types of health workers targeted
1.4.2 Geographical areas covered
1.4.3 Categories of interventions covered
1.5 Process for formulating the global recommendations
1.6 Dissemination process
1.7 Methodology
1.8 Structure of the report
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
2.2 Ensure rural retention policies are part of the national health plan
2.3 Understand the health workforce
2.4 Understand the wider context
2.5 Strengthen human resource management systems
2.6 Engage with all relevant stakeholders from the beginning of the process
2.7 Get into the habit of evaluation and learning
3. Evidence-based recommendations to improve attraction, recruitment and retention of health workers in remote and rural areas
3.1 Education
3.1.1 Get the “right” students
3.1.2 Train students closer to rural communities
3.1.3 Bring students to rural communities
3.1.4 Match curricula with rural health needs
3.1.5 Facilitate professional development
3.2 Regulatory interventions
3.2.1 Create the conditions for rural health workers to do more
3.2.2 Train more health workers faster to meet rural health needs
2 3.2.3 Make the most of compulsory service
3.2.4 Tie education subsidies to mandatory placements
3.3 Financial incentives
3.3.1 Make it worthwhile to move to a remote or rural area
3.4 Personal and professional support
3.4.1 Pay attention to living conditions
3.4.2 Ensure the workplace is up to an acceptable standard
3.4.3 Foster interaction between urban and rural health workers
3.4.4 Design career ladders for rural health workers
3.4.5 Facilitate knowledge exchange
3.4.6 Raise the profile of rural health workers
4. Measuring results: how to select, implement and evaluate rural retention policies 35
4.1 Relevance: which interventions best respond to national priorities and the expectations of health workers and rural communities?
4.2 Acceptability: which interventions are politically acceptable and have the most stakeholder support?
4.3 Affordability: which interventions are affordable?
4.4 Effectiveness: have complementarities and potential unintended consequences between various interventions been considered?
4.5 Impact: what indicators will be used to measure impact over time?
5. Research gaps and research agenda
5.1 Research gaps
5.1.1 Study all types of health workers
5.1.2 More research in low-income countries
5.1.3 More well-designed evaluations
5.1.4 Quality of the evidence – not only “what works”, but also “why” and “how”
5.2 Research agenda
6. Deciding on the strength of the recommendations
Methodology
List of participants
References
Annexes
:: Annex 1 – Grade evidence profiles [pdf 151kb]
:: Annex 2 – Descriptive evidence profiles [pdf 220kb]
Executive summary :: Download [pdf 37kb]
Related link
:: WHO Global Code of Practice on the International Recruitment of Health Personnel
Resolution WHA63.16 is included as Annex 3 in the CD attached to the printed version of the global policy recommendations.
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