Publication:
How to Recruit and Retain Health Workers in Rural and Remote Areas in Developing Countries : A Guidance Note

Loading...
Thumbnail Image
Files in English
English PDF (1.27 MB)
2,375 downloads
English Text (166.33 KB)
139 downloads
Date
2013-06
ISSN
Published
2013-06
Editor(s)
Abstract
Worldwide the geographical distribution of health workers is skewed towards urban and wealthier areas. This pattern is found in nearly every country in the world, regardless of the level of economic development and health system organization, but the problem is especially acute in developing countries. The geographical imbalances in the health workforce further exacerbate inequities in the health sector, as the services are not available where needs are higher and impact greater. A variety of interventions have been applied in different contexts and for different types of health workers to address this problem. There is an emerging consensus that policies for recruitment and retention in rural and remote areas need to address two critical issues: i) to be effective, interventions need to be implemented in bundles, combining different packages of interventions according to the variety of factors influencing the health worker's decision to work in rural or remote areas; and ii) to match the interventions with health worker's preferences and expectations, since the health worker's employment decisions are a function of these preferences. In order to respond to these requirements, this paper proposes the application of Discrete Choice Experiments (DCEs) to allow for measurement of health workers' preferences and quantitatively predicts the job uptake given a set of job characteristics. This paper has a two-fold objective: a) to give the reader an overview of the magnitude of unequal health workforce distribution in the developing countries, provide a summary of the evidence to date on the factors that contribute to these imbalances, and present a systematic set of policy interventions that are being implemented around the world to address the problem of recruitment and retention of health workers in rural and remote regions of the developing countries; and b) to introduce the reader to the potential application of the DCE to elicit health workers' preferences and determine the factors likely to increase their probability of taking up a rural or remote job.
Link to Data Set
Citation
Araújo, Edson; Maeda, Akiko. 2013. How to Recruit and Retain Health Workers in Rural and Remote Areas in Developing Countries : A Guidance Note. HNP Discussion Paper;. © World Bank. http://hdl.handle.net/10986/16104 License: CC BY 3.0 IGO.
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    The Labor Market for Health Workers in Africa : New Look at the Crisis
    (Washington, DC: World Bank, 2013-04-17) Soucat, Agnes; Scheffler, Richard; Soucat, Agnes; Scheffler, Richard; Ghebreyesus, Tedros Adhanom
    Health systems in Sub-Saharan Africa have changed profoundly over the last 20 years. The economic crisis of the 1980s and 1990s rattled public health care systems, which were largely holdovers from the colonial and postcolonial eras. The later wave of structural adjustments and public sector reforms wrought further change. As African economies opened to market based approaches, the private sector became a sizable source of health care service. Today about half the health expenditures in Africa are private, and private providers play a major role in the delivery of outpatient services. This is draws on the lessons, knowledge, and data gathered by the World Bank's Africa Region Human Resources for Health Program. For the first time, the various complexities of Human Resources for Health (HRH) labor markets are addressed comprehensively in one volume. Given the increasing demand in countries for strong health workforces that can help achieve universal health coverage; we hope this book will be beneficial to researchers, policy makers, and practitioners who are trying to develop evidence-based HRH interventions to achieve this end.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : A Synthesis of 11 Country Case Studies
    (Washington, DC: World Bank, 2014-06-25) Maeda, Akiko; Araujo, Edson; Cashin, Cheryl; Harris, Joseph; Ikegami, Naoki; Reich, Michael R.
    The goals of Universal Health Coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey that have achieved UHC are showing how these programs can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low income and middle-income countries (LMICs), where most of the world s poor live.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Brazil
    (World Bank Group, Washington, DC, 2014-09) Araujo, Edson C.; Lindelow, Magnus
    Over the last 20 years, Brazil has seen profound economic, political, and demographic changes. After a period of military dictatorship (from 1964 to 1985), political and economic stability was achieved in the mid-1990s. The country has urbanized, improved access to water and sanitation, achieved solid economic growth, and reduced income inequality. It was one of the first Latin American countries to establish universal health coverage (UHC) as a fundamental right, based on the principles that health care is a duty of the state and should be free at the point of use. The reform in the late 1980s created the Unified Health System (Sistema Único de Saúde, or SUS) and was based on the principle that health care should be free at the point of use to all Brazilian citizens.
  • Publication
    Contracting for Primary Health Care in Brazil : The Cases of Bahia and Rio de Janeiro
    (World Bank Group, Washington, DC, 2014-09) Araujo, Edson; Cavalini, Luciana; Girardi, Sabado; Ireland, Megan; Lindelow, Magnus
    This study presents two case studies, each on a current initiative of contracting for primary health services in Brazil, one for the state of Bahia, the other for the city of Rio de Janeiro. The two initiatives are not linked and their implementation has independently sprung from a search for more effective ways of delivering public primary health care. The two models differ considerably in context, needs, modalities, and outcomes. This paper identifies their strengths and weaknesses, initially by providing a background to universal primary health care in Brazil, paying particular attention to the family health strategy, the driver of the basic health care model. It then outlines the history of contracting for health care within Brazil, before analyzing the two studies. The state of Bahia sought to expand coverage of the family health strategy and increase the quality of services, but had difficulty in attracting and retaining qualified health professionals. Rigidities in the process of public hiring led to a number of isolated contracting initiatives at the municipal level and diverse, often unstable employment contracts. The state and municipalities decided to centralize the hiring of health professionals in order to offer stable positions with career plans and mobility within the state, and chose to create a state foundation, acting under private law to manage and oversee this process. Results have been mixed as lower than expected municipal involvement resulted in relatively high administrative costs and consequent default on municipal financial contributions. The state foundation is undergoing a governance reform and has now diversified beyond hiring for primary care. The municipality of Rio de Janeiro, which until recently relied on an expansive hospital network for health care delivery, sought in particular to expand primary health services. The public health networks suffered from inefficiency and poor quality, and it was therefore decided to contract privately owned and managed, not-for-profit, social organizations to provide primary care services. The move has succeeded in attracting considerable increases in funding for primary health and coverage has increased significantly. Performance initiatives, however, still need fine-tuning and reliable information systems must be implanted in order to evaluate the system.
  • Publication
    The Contribution of Traditional Herbal Medicine Practitioners to Kenyan Health Care Delivery : Results from Community Health-seeking Behavior Vignettes and a Traditional Herbal Medicine Practitioner Survey
    (World Bank, Washington, DC, 2011-09) Lambert, John; Leonard, Kenneth; Mungai, Geoffrey; Omindi-Ogaja, Elizabeth; Gatheru, Gladys; Mirangi, Mirangi; Owara, Jennifer; Herbst, Christopher H.; Ramana, GNV; Lemiere, Christophe
    This study examines the role that Traditional Herbal Medicine Practitioners (THMPs) play in Kenya in the context of its human resources for health crisis. Two surveys were carried out to obtain evidence. The first documented the choices and perceptions of households in 36 communities on seeking medical assistance for eight common illnesses. The second survey asked 258 THMPs in five provinces to identify their knowledge sources, training, common illnesses treated, forms of payment, challenges, and concerns. Community-derived data show that households make reasonable decisions when faced with difficult circumstances: they prefer hospitals when these are affordable and seek care at clinics and health centers when hospitals are too far away. There is significant self-care and use of pharmacies, although THMPs are preferred for worms and lower respiratory problems. In general, THMPs provide an important though diminishing role in the provision of health care; they are not sought out in situations when inadequate care is dangerous, specifically infant diarrhoea and potential TB. Whilst Human Resources for Health (HRH) policies are urgently required to strengthen the conventional health workforce and increase their accessibility for the poor, policies should not ignore the findings from this study: many of the rural poor currently receive services from a traditional health workforce not linked to, or regulated by, the national government. This paper argues that formal recognition of their role by the government and by the conventional medical associations, and a targeted strategy to strengthen and build on the positive qualities evident in many traditional medicine practices may be beneficial to safeguarding the well-being of the poor.

Users also downloaded

Showing related downloaded files

  • Publication
    Doing Business 2020
    (Washington, DC: World Bank, 2020) World Bank
    Doing Business 2020 is the 17th in a series of annual studies investigating the regulations that enhance business activity and those that constrain it. It provides quantitative indicators covering 12 areas of the business environment in 190 economies. The goal of the Doing Business series is to provide objective data for use by governments in designing sound business regulatory policies and to encourage research on the important dimensions of the regulatory environment for firms.
  • Publication
    Poverty and Shared Prosperity 2016
    (Washington, DC: World Bank, 2016-10-02) World Bank Group
    Poverty and Shared Prosperity 2016 is the first of an annual flagship report that will inform a global audience comprising development practitioners, policy makers, researchers, advocates, and citizens in general with the latest and most accurate estimates on trends in global poverty and shared prosperity. This edition will also document trends in inequality and identify recent country experiences that have been successful in reducing inequalities, provide key lessons from those experiences, and synthesize the rigorous evidence on public policies that can shift inequality in a way that bolsters poverty reduction and shared prosperity in a sustainable manner. Specifically, the report will address the following questions: • What is the latest evidence on the levels and evolution of extreme poverty and shared prosperity? • Which countries and regions have been more successful in terms of progress toward the twin goals and which are lagging behind? • What does the global context of lower economic growth mean for achieving the twin goals? • How can inequality reduction contribute to achieving the twin goals? • What does the evidence show concerning global and between- and within-country inequality trends? • Which interventions and countries have used the most innovative approaches to achieving the twin goals through reductions in inequality? The report will make four main contributions. First, it will present the most recent numbers on poverty, shared prosperity, and inequality. Second, it will stress the importance of inequality reduction in ending poverty and boosting shared prosperity by 2030 in a context of weaker growth. Third, it will highlight the diversity of within-country inequality reduction experiences and will synthesize experiences of successful countries and policies, addressing the roots of inequality without compromising economic growth. In doing so, the report will shatter some myths and sharpen our knowledge of what works in reducing inequalities. Finally, it will also advocate for the need to expand and improve data collection—for example, data availability, comparability, and quality—and rigorous evidence on inequality impacts in order to deliver high-quality poverty and shared prosperity monitoring.
  • Publication
    The African Continental Free Trade Area
    (Washington, DC: World Bank, 2020-07-27) World Bank; Maliszewska, Maryla; Ruta, Michele
    The African Continental Free Trade Area (AfCFTA) agreement will create the largest free trade area in the world, measured by the number of countries participating. The pact will connect 1.3 billion people across 55 countries with a combined GDP valued at $3.4 trillion. It has the potential to lift 30 million people out of extreme poverty by 2035. But achieving its full potential will depend on putting in place significant policy reforms and trade facilitation measures. The scope of the agreement is considerable. It will reduce tariffs among member countries and cover policy areas, such as trade facilitation and services, as well as regulatory measures, such as sanitary standards and technical barriers to trade. It will complement existing subregional economic communities and trade agreements by offering a continent-wide regulatory framework and by regulating policy areas—such as investment and intellectual property rights protection—that have not been covered in most subregional agreements. The African Continental Free Trade Area: Economic and Distributional Effects quantifies the long-term implications of the agreement for growth, trade, poverty reduction, and employment. Its analysis goes beyond that in previous studies that have largely focused on tariff and nontariff barriers in goods—by including the effects of services and trade facilitation measures, as well as the distributional impacts on poverty, employment, and wages of female and male workers. It is designed to guide policy makers as they develop and implement the extensive range of reforms needed to realize the substantial rewards that the agreement offers. The analysis shows that full implementation of AfCFTA could boost income by 7 percent, or nearly $450 billion, in 2014 prices and market exchange rates. The agreement would also significantly expand African trade—particularly intraregional trade in manufacturing. In addition, it would increase employment opportunities and wages for unskilled workers and help close the wage gap between men and women.
  • Publication
    Poverty and Shared Prosperity 2018
    (Washington, DC: World Bank, 2018-10-17) World Bank
    The World Bank Group has two overarching goals: End extreme poverty by 2030 and promote shared prosperity by boosting the incomes of the bottom 40 percent of the population in each economy. As this year’s Poverty and Shared Prosperity report documents, the world continues to make progress toward these goals. In 2015, approximately one-tenth of the world’s population lived in extreme poverty, and the incomes of the bottom 40 percent rose in 77 percent of economies studied. But success cannot be taken for granted. Poverty remains high in Sub- Saharan Africa, as well as in fragile and conflict-affected states. At the same time, most of the world’s poor now live in middle-income countries, which tend to have higher national poverty lines. This year’s report tracks poverty comparisons at two higher poverty thresholds—$3.20 and $5.50 per day—which are typical of standards in lower- and upper-middle-income countries. In addition, the report introduces a societal poverty line based on each economy’s median income or consumption. Poverty and Shared Prosperity 2018: Piecing Together the Poverty Puzzle also recognizes that poverty is not only about income and consumption—and it introduces a multidimensional poverty measure that adds other factors, such as access to education, electricity, drinking water, and sanitation. It also explores how inequality within households could affect the global profile of the poor. All these additional pieces enrich our understanding of the poverty puzzle, bringing us closer to solving it. For more information, please visit worldbank.org/PSP
  • Publication
    Poverty and Shared Prosperity 2020
    (Washington, DC: World Bank, 2020-10-07) World Bank
    Previous Poverty and Shared Prosperity Reports have conveyed the difficult message that the world is not on track to meet the global goal of reducing extreme poverty to 3 percent by 2030. This edition brings the unwelcome news that COVID-19, along with conflict and climate change, has not merely slowed global poverty reduction but reversed it for first time in over twenty years. With COVID-19 predicted to push up to 100 million additional people into extreme poverty in 2020, trends in global poverty rates will be set back at least three years over the next decade. Today, 40 percent of the global poor live in fragile or conflict-affected situations, a share that could reach two-thirds by 2030. Multiple effects of climate change could drive an estimated 65 to 129 million people into poverty in the same period. “Reversing the reversal” will require responding effectively to COVID-19, conflict, and climate change while not losing focus on the challenges that most poor people continue to face most of the time. Though these are distinctive types of challenges, there is much to be learned from the initial response to COVID-19 that has broader implications for development policy and practice, just as decades of addressing more familiar development challenges yield insights that can inform responses to today’s unfamiliar but daunting ones. Solving novel problems requires rapid learning, open cooperation, and strategic coordination by everyone: from political leaders and scientists to practitioners and citizens.