Academic journal article Bulletin of the World Health Organization

Evaluated Strategies to Increase Attraction and Retention of Health Workers in Remote and Rural areas/Evaluation De Strategies Pour Attirer Davantage et Retenir le Personnel Medical Dans Les Zones Rurale Ou reculees/Evaluacion De Estrategias De Aumento De la Captacion Y Permanencia De Trabajadores Sanitarios En Zonas Remotas V Rurales

Academic journal article Bulletin of the World Health Organization

Evaluated Strategies to Increase Attraction and Retention of Health Workers in Remote and Rural areas/Evaluation De Strategies Pour Attirer Davantage et Retenir le Personnel Medical Dans Les Zones Rurale Ou reculees/Evaluacion De Estrategias De Aumento De la Captacion Y Permanencia De Trabajadores Sanitarios En Zonas Remotas V Rurales

Article excerpt

Introduction

The availability of well trained and motivated health workers in underserved areas will improve access to essential health services to achieve the health-related United Nations' Millennium Development Goals within the framework of a primary health care renewal. (1-3) Yet there are stark imbalances in the geographical distribution of health workers, both in developed and developing countries. Approximately one half of the world's population lives in rural areas but these areas are served by only 38% of the total nursing workforce and by less than 25% of the total physicians' workforce. (2) At the country level, imbalances in the distribution of health workers are even more prominent. (4,5)

In recent years, there has been increased interest from both researchers and policy-makers to identify and implement effective solutions to address the shortages of health workers in remote and rural areas. (6-11) In response to this increased interest and perceived need, the World Health Organization has recently launched a programme of work on "Increasing access to health workers in remote and rural areas through improved retention." The programme aims to expand the knowledge base in this domain and to provide evidence-based global recommendations to address this problem, while at the same time to provide technical cooperation to countries that need to address this problem. (12)

As part of this programme of work, this paper builds on and expands earlier work on assessing the evidence on effectiveness of interventions to increase access to health workers in rural and remote areas. (13) This paper expands the original search to focus mainly on studies that evaluated such interventions, and attempts to analyse the impact of such interventions on certain dimensions of health workforce and health systems performance. It also discusses the quality of the evidence from evaluation studies and identifies the evidence gaps in this domain. It is expected that evaluations would give policy-makers additional information with regards to the effectiveness and applicability of various interventions in their own context. (14)

Conceptual framework

The analysis in this paper is based on the assumption that the final result of having health workers in remote and rural areas depends on two inter-linked aspects (8): (i) the factors that influence the decision or choice of health workers to relocate to, stay in or leave those areas, and (ii) the extent to which health system policies and interventions respond to these factors. These responses are usually grouped into four main categories: education, regulatory, financial and personal and professional support interventions. (6-10)

There is a wealth of descriptive literature highlighting the extent of geographical imbalances and deficits in health personnel in rural and remote areas, (4,5) or reporting on the factors that influence health workers' preferences or choices with regards to practicing in remote and rural areas. (15,16) There are also studies that describe or recommend potential interventions, without analysing the effects of these interventions. (17-19) However, there is very limited research on comprehensive evaluations of specific retention strategies. We set out to conduct a review of this type of study with the aim of further informing the methodology in conducting evaluations of rural health workforce retention strategies.

Methods

We conducted an extensive review of the literature that reported on evaluations of interventions to increase the availability of health workers in remote and rural areas. Electronic searches were conducted in August and September 2009 in PubMed, the Cochrane database, Embase[R] and LILACS. Reference lists of the retrieved studies were also searched to complement the final list of articles. Further evidence was gathered from experts in the field of human resources for health, and from grey literature, through searches in Google, the Human Resources for Health Global Resource Centre and various web sites of government ministries. …

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