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<div class="gmail_quote">From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <span dir="ltr"><<a href="mailto:ruglucia@paho.org">ruglucia@paho.org</a>></span><br>crossposted from: <a href="mailto:EQUIDAD@listserv.paho.org">EQUIDAD@listserv.paho.org</a><br>
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<h1 style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="maroon" size="3"><span style="FONT-SIZE: 12pt; COLOR: maroon; FONT-FAMILY: Arial">Increasing access to health workers in remote and rural areas through improved retention<br>
Global Policy Recommendations<br><br></span></font></b></h1>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">World Health Organization - </span></font></b><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> July 2010 </span></font></b><strong><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: normal; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">ISBN</span></font></b></strong><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">: 9789241564014<br>
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<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Available online PDF [79p.] at: <a href="http://bit.ly/bw3qy9" target="_blank"><font color="navy"><span style="COLOR: navy">http://bit.ly/bw3qy9</span></font></a> <br>
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<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">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.</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">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.<br>
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<h3 style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: normal; FONT-SIZE: 10pt; TEXT-TRANSFORM: uppercase; COLOR: navy; FONT-FAMILY: Arial">Annexes</span></font></b></h3>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><span><b><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">::</span></font></b></span><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> <a href="http://www.who.int/entity/hrh/retention/annex1_grade_evidence_profiles.pdf" target="_blank"><font color="navy"><span style="COLOR: navy">Annex 1 – Grade evidence profiles [pdf 151kb]</span></font></a> <br>
<span><b><font face="Arial" color="navy"><span style="COLOR: navy; FONT-FAMILY: Arial">::</span></font></b></span> <a href="http://www.who.int/entity/hrh/strategy/annex2_descriptive_evidence_profiles.pdf" target="_blank"><font color="navy"><span style="COLOR: navy">Annex 2 – Descriptive evidence profiles [pdf 220kb]</span></font></a><br>
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<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 11pt; COLOR: navy; FONT-FAMILY: Arial">Tables of contents</span></font></b></p>
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<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">Preface </span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">Contributors and acknowledgments </span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">Executive Summary <br><br></span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="1"><span style="FONT-WEIGHT: bold; FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">1. Introduction </span></font></b><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.1 Rationale 7</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.2 Objective 8</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.3 Target audience 8</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.4 Scope 9</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.4.1 Types of health workers targeted 9</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.4.2 Geographical areas covered 9</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.4.3 Categories of interventions covered 10</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.5 Process for formulating the global recommendations 10</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.6 Dissemination process 11</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.7 Methodology 11</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">1.8 Structure of the report 11<br><br></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="1"><span style="FONT-WEIGHT: bold; FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">2. Principles to guide the formulation of national policies to improve retention of health workers in remote and rural areas </span></font></b><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">2.1 Focus on health equity 13</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">2.2 Ensure rural retention policies are part of the national health plan 13</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">2.3 Understand the health workforce 14</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">2.4 Understand the wider context 14</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">2.5 Strengthen human resource management systems 15</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">2.6 Engage with all relevant stakeholders from the beginning of the process 16</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">2.7 Get into the habit of evaluation and learning 16<br><br></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="1"><span style="FONT-WEIGHT: bold; FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">3. Evidence-based recommendations to improve attraction, recruitment and retention of health workers in remote and rural areas </span></font></b><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.1 Education 18</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.1.1 Get the “right” students 18</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.1.2 Train students closer to rural communities 19</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.1.3 Bring students to rural communities 21</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.1.4 Match curricula with rural health needs 21</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.1.5 Facilitate professional development 22</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.2 Regulatory interventions 23</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.2.1 Create the conditions for rural health workers to do more 23</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.2.2 Train more health workers faster to meet rural health needs 24</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">2 3.2.3 Make the most of compulsory service 25</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.2.4 Tie education subsidies to mandatory placements 26</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.3 Financial incentives 27</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.3.1 Make it worthwhile to move to a remote or rural area 28</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.4 Personal and professional support 29</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.4.1 Pay attention to living conditions 30</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.4.2 Ensure the workplace is up to an acceptable standard 31</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.4.3 Foster interaction between urban and rural health workers 31</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.4.4 Design career ladders for rural health workers 32</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.4.5 Facilitate knowledge exchange 33</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">3.4.6 Raise the profile of rural health workers 34<br><br></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="1"><span style="FONT-WEIGHT: bold; FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">4. Measuring results: how to select, implement and evaluate rural retention policies </span></font></b><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">4</span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">.1 Relevance: which interventions best respond to national priorities and the expectations of health workers and rural communities? 36</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">4.2 Acceptability: which interventions are politically acceptable and have the most stakeholder support? 36</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">4.3 Affordability: which interventions are affordable? 38</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">4.4 Effectiveness: have complementarities and potential unintended consequences between various interventions been considered? 38</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">4.5 Impact: what indicators will be used to measure impact over time? 39<br>
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<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="1"><span style="FONT-WEIGHT: bold; FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">5. Research gaps and research agenda </span></font></b><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">5.1 Research gaps 42</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">5.1.1 Study all types of health workers 42</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">5.1.2 More research in low-income countries 42</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">5.1.3 More well-designed evaluations 42</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">5.1.4 Quality of the evidence – not only “what works”, but also “why” and “how” 42</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 1in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">5.2 Research agenda 43<br><br></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="1"><span style="FONT-WEIGHT: bold; FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">6. Deciding on the strength of the recommendations </span></font></b><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">44</span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="1"><span style="FONT-WEIGHT: bold; FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">Methodology </span></font></b><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="1"><span style="FONT-WEIGHT: bold; FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">List of participants </span></font></b><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial"></span></font></p>
<p class="MsoNormal" style="TEXT-INDENT: 0.5in"><b><font face="Arial" color="navy" size="1"><span style="FONT-WEIGHT: bold; FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">References<br> </span></font></b></p>
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