PHM-Exch> Increasing access to health workers in remote and rural areas through improved retention- Global Policy Recommendations

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org


 *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]<http://www.who.int/entity/hrh/retention/annex1_grade_evidence_profiles.pdf>
*::* Annex 2 – Descriptive evidence profiles [pdf
220kb]<http://www.who.int/entity/hrh/strategy/annex2_descriptive_evidence_profiles.pdf>



*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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