Retaining health workforce in rural and underserved areas of India

What works and what doesn't? A critical interpretative synthesis

Sonu Goel, Federica Angeli, Nidhi Bhatnagar*, Neetu Singla, Manoj Grover, Hans Maarse

*Corresponding author for this work

Research output: Contribution to journalReview articleScientificpeer-review

Abstract

Background. Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas.

Methods. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low and middle-income countries.

Results. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas.

Conclusions. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence based strategies are needed to ensure context-specific, field-tested and cost-effective solutions to various existing problems. To ensure retention these strategies must be integrated with effective human resource management policies and rural orientation of the medical education system.

Original languageEnglish
Pages (from-to)212-218
Number of pages7
JournalNational medical journal of india
Volume29
Issue number4
Publication statusPublished - 2016
Externally publishedYes

Keywords

  • MEDICAL-EDUCATION
  • SERVICE
  • RETENTION
  • STUDENTS
  • CARE
  • SUPERVISION
  • RECRUITMENT
  • DOCTORS
  • NEED

Cite this

Goel, Sonu ; Angeli, Federica ; Bhatnagar, Nidhi ; Singla, Neetu ; Grover, Manoj ; Maarse, Hans. / Retaining health workforce in rural and underserved areas of India : What works and what doesn't? A critical interpretative synthesis. In: National medical journal of india. 2016 ; Vol. 29, No. 4. pp. 212-218.
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title = "Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis",
abstract = "Background. Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8{\%}), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas.Methods. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low and middle-income countries.Results. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas.Conclusions. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence based strategies are needed to ensure context-specific, field-tested and cost-effective solutions to various existing problems. To ensure retention these strategies must be integrated with effective human resource management policies and rural orientation of the medical education system.",
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Retaining health workforce in rural and underserved areas of India : What works and what doesn't? A critical interpretative synthesis. / Goel, Sonu; Angeli, Federica; Bhatnagar, Nidhi; Singla, Neetu; Grover, Manoj; Maarse, Hans.

In: National medical journal of india, Vol. 29, No. 4, 2016, p. 212-218.

Research output: Contribution to journalReview articleScientificpeer-review

TY - JOUR

T1 - Retaining health workforce in rural and underserved areas of India

T2 - What works and what doesn't? A critical interpretative synthesis

AU - Goel, Sonu

AU - Angeli, Federica

AU - Bhatnagar, Nidhi

AU - Singla, Neetu

AU - Grover, Manoj

AU - Maarse, Hans

PY - 2016

Y1 - 2016

N2 - Background. Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas.Methods. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low and middle-income countries.Results. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas.Conclusions. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence based strategies are needed to ensure context-specific, field-tested and cost-effective solutions to various existing problems. To ensure retention these strategies must be integrated with effective human resource management policies and rural orientation of the medical education system.

AB - Background. Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas.Methods. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low and middle-income countries.Results. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas.Conclusions. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence based strategies are needed to ensure context-specific, field-tested and cost-effective solutions to various existing problems. To ensure retention these strategies must be integrated with effective human resource management policies and rural orientation of the medical education system.

KW - MEDICAL-EDUCATION

KW - SERVICE

KW - RETENTION

KW - STUDENTS

KW - CARE

KW - SUPERVISION

KW - RECRUITMENT

KW - DOCTORS

KW - NEED

M3 - Review article

VL - 29

SP - 212

EP - 218

JO - National medical journal of india

JF - National medical journal of india

SN - 0970-258X

IS - 4

ER -