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

[Claudio Schuftan]

*From: *"Ruggiero, Mrs. Ana Lucia (WDC)" <ruglucia at PAHO.ORG>
*CROSSPOSTED FROM: *"Equity, Health & Human Development" <
EQUIDAD at LISTSERV.PAHO.ORG>

*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]<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>
*EXECUTIVE SUMMARY **::* Download [pdf
37kb]<http://www.who.int/entity/hrh/retention/Executive_Summary_Recommendations_EN.pdf>
*RELATED LINK*
*::* WHO Global Code of Practice on the International Recruitment of Health
Personnel<http://www.who.int/entity/hrh/migration/code/practice/en/index.html>
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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