Publication: Health Worker Attitudes toward Rural Service in India : Results from Qualitative Research
Loading...
Date
2010-11
ISSN
Published
2010-11
Editor(s)
Abstract
The paucity of qualified health workers in rural areas is a critical challenge for India's health sector. Although state governments have instituted several mechanisms, salary and non-salary, to attract health workers to rural areas, individually these mechanisms typically focus on single issues (e.g. salary). This qualitative study explores the career preferences of under-training and in-service doctors and nurses and identifies factors important to them to take up rural service. It then develops a framework for clustering these complex attributes into potential ?incentive packages for better rural recruitment and retention. The study was carried out in two geographically diverse Indian states, Uttarakhand and Andhra Pradesh. A total of 80 in-depth interviews were conducted with a variety of participants: medical students (undergraduate, postgraduate, and Indian system of medicine), nursing students, and doctors and nurses in primary health centers. The information collected was clustered by constructing several hierarchical displays, and collated into job-attribute matrixes. The findings indicate that, while financial and educational incentives attract doctors and nurses to rural postings, they do not make effective retention strategies. Frustration among rural health workers often stems from the lack of infrastructure, support staff, and drugs, a feeling exasperated by local political interference and lack of security.
Link to Data Set
Citation
โRao, Krishna D.; Ramani, Sudha; Murthy, Seema; Hazarika, Indrajit; Khandpur, Neha; Chokshi, Maulik; Khanna, Saujanya; Vujicic, Marko; Berman, Peter; Ryan, Mandy. 2010. Health Worker Attitudes toward Rural Service in India : Results from Qualitative Research. Health, Nutrition and Population (HNP)
discussion paper;. ยฉ World Bank. http://hdl.handle.net/10986/13605 License: CC BY 3.0 IGO.โ
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India(World Bank, Washington, DC, 2012-08)India faces significant challenges in attracting qualified health workers to rural areas. In 2010 the authors conducted a Discrete Choice Experiment (DCE) in the Indian states of Uttarakhand and Andhra Pradesh to understand what health departments in India could do to make rural service more attractive for doctors and nurses. Specifically, we wanted to do the following: (a) examine the effect of monetary and nonmonetary job attributes on health worker job choices; and (b) develop incentive 'packages' with a focus on jobs in rural areas. The study sample included medical students, nursing students, in-service doctors and nurses at primary health centers. An initial qualitative study identified eight job attributes health center type, area, health facility infrastructure, staff and workload, salary, guaranteed transfer to city or town after some years of service, professional development, and job in native area. Respondents were required to choose between a series of hypothetical job pairs that were characterized by different attribute-level combinations. Bivariate probit and mixed logit regression was used for the statistical analysis of the choice responses. The findings suggest that the supply of medical graduates for rural jobs remained inelastic in the presence of individual monetary and nonmonetary incentives. In contrast, the supply of nursing students for rural jobs was elastic. Further, medical and nursing students from rural areas had a greater inclination to take up rural jobs. The supply of in-service doctors and nurses for rural posts was elastic. Higher salary and easier enrolment in higher education programs in lieu of some years of rural service emerged as the most powerful driver of job choice. Overall, better salary, good facility infrastructure, and easier enrolment in higher education programs appear to be the most effective drivers of uptake of rural posts for students and in-service workers. Combining these incentives can substantially increase rural recruitment. Incentivizing medical graduates to take up rural service appears to be challenging in India's context. This can be improved to some extent by offering easier admission to specialist training and recruiting students from rural backgrounds. In contrast, nursing students and in-services nurses are much more receptive to incentives for uptake of rural service. This suggests that cadres such as nurse practitioners can play an important role in delivering primary care services in rural India.Publication The Resilience of Women in Higher Education in Afghanistan(World Bank, Washington, DC, 2015-01)Female access to higher education in Afghanistan is has been and continues to be limited. At the basic education level, the country has made great advances since 2000; it increased access from 900,000 students in 2000, almost all boys, to 6.7 million students in 2009, and girl s enrollment increased from 5,000 under the Taliban to 2.4 million in the same time period (Afghanistan, Ministry of Education 2009-2010). Seventy-one percent are currently enrolled in primary and middle school (Grades 1-9) and 29 percent are enrolled in secondary education (Grades 10-12; Samady 2013). The post-secondary gains for girls have already increased, as 120,000 girls have graduated from secondary school, and 15,000 have enrolled in universities (George W. Bush Institute 2013). Every year, more than 100,000 secondary school graduates write the Kankor, the nationwide higher education entrance exam, but due to insufficient spaces and limited capacity, only about half of those students find a spot at the government universities and colleges (UN Women 2013). Of the total number of university students, in 2009 only 24.8 percent were female (CEDAW 2011). The issue is not only access, but also retention and graduation. Even when female students enter universities, they require relevant support for gender-specific risks to help them complete their higher education careers. The authors need to learn more about the barriers to entering higher education, as well as to graduating successfully. Equally important is the need to understand what are the strengths, opportunities and resources that can help young girls and women consider, access, and acquire a quality higher education degree to contribute to the on-going development of their families, society and the country.Publication Political Economy of Health Workforce Policy : The Chhattisgarh Experience with a Three-year Course for Rural Health Care Practitioners(World Bank, Washington, DC, 2010-03)This case study analyzes the reasons for adoption and the implementation process of a key policy in Chhattisgarh state, India, to create a rural cadre of trained physicians in order to address the acute shortage of doctors in the state's primary health facilities. It documents the experience specific to Chhattisgarh state, but with its attention to the policy processes and implementation challenges associated, it also highlights the necessity of a political economy perspective currently missing in much of the published literature on human resources for health. A principal lesson of this case concerns why it matters how interests of various stakeholders who had interests in the three-year course are included early in the policy process, namely the anticipated opposition of the medical doctor community represented by the Indian Medical Association (IMA) and the interests of the students themselves and their desire to be given appropriate status as medical doctors. This case study addresses the legal hurdles faced and the importance of institutional support structures to maintain quality standards and provide for grievance procedures. Through this case study, it also becomes apparent why the role of institutional ownership of policy matters rather than success or failure of policy that is linked entirely to the authority of a few key appointed officials.Publication The Nurse Labor and Education Markets in the English-Speaking CARICOM : Issues and Options for Reform(World Bank, 2009-06-01)The present report concludes the second phase of the cooperation between Caribbean Community (CARICOM) countries and the World Bank to build skills for a competitive regional economy. It focuses on the nurse labor and education markets of the English-speaking (ES) CARICOM. The topic was suggested by ministers of health concerned with chronic staffing shortages in local health facilities and anecdotal evidence of high migratory outflows. The chronic staff shortages are likely to hamper the quality and efficiency of health services, both of which are critical factors in attracting international businesses and retirement locales. The rationale for focusing on nurses was that they compose the largest group of health care professionals in the ES CARICOM and play a critical role in strengthening health services in the face of the demographic and epidemiological transition in the region. Moreover, major achievements in improving and harmonizing curricula, degrees, and licensing procedures among the ES countries of CARICOM facilitate the international competition for this globally scarce human resource. If the ES CARICOM is to address current and future nurse shortages, be increasingly protected against a large outflow of nurses, and simultaneously recognize an individual's right to freedom of movement and right to access health services, then various policies must be examined. Ultimately, believe that a false dichotomy exists between choosing to focus on increasing nurse training capacity versus focusing on managing migration; in fact, both must be done jointly and immediately. If the ES CARICOM is to address current and future nurse shortages, be increasingly protected against a large outflow of nurses and simultaneously recognize an individual's right to freedom of movement, the ES CARICOM must both increase the number of nurse graduates and manage migration.Publication Analysis of Health Workforce Retention and Attraction Policies in Lao PDR(World Bank, Washington, DC, 2014-03)Worldwide, Lao PDR has been identified among 57 countries with a critical shortage and skewed distribution of its health workforce, especially in remote and rural areas (Guilbert 2006, World Bank 2015). Healthcare education is provided by the public sector through nine public health training institutes in the country: The University of Health Sciences (UHS) in Vientiane Capital provides medical related programs including medicine, dentistry, pharmacy, medical technology, nursing basic sciences and post graduate studies, with the other institutions located at provincial levels: three Regional Public Health Colleges, four Provincial Public Health Schools and one Nursing School. The annual output from these institutions is approximately 2,000 (Department of Organization and Personnel (DOP), 2013). This study focuses on supply-side policies to determine the key challenges and policy implications regarding improved availability and retention of staff in remote areas. This possibly stems from, among other reasons, the following: (a) limited government quotas to recruit and place health workers in rural areas (i.e. in 2013 1,045 recruitment quotas were allocated to MOH, of which 882 (84.4 percent) were given to provinces, districts and health centers nationwide); (b) health workersโpreference to work in urban areas with better income and professional career development opportunities; and (c) low self-confidence of new graduates to work independently in rural areas which is attributable to insufficient clinical practice during training, due in part to the excessive number of student intakes to training institutes. The shortage of middle and high level health workers at primary and secondary health care facility levels leads to a major gap in access to quality health care services between urban and rural areas.
Users also downloaded
Showing related downloaded files
Publication Remarks at the United Nations Biodiversity Conference(World Bank, Washington, DC, 2021-10-12)World Bank Group President David Malpass discussed biodiversity and climate change being closely interlinked, with terrestrial and marine ecosystems serving as critically important carbon sinks. At the same time climate change acts as a direct driver of biodiversity and ecosystem services loss. The World Bank has financed biodiversity conservation around the world, including over 116 million hectares of Marine and Coastal Protected Areas, 10 million hectares of Terrestrial Protected Areas, and over 300 protected habitats, biological buffer zones and reserves. The COVID pandemic, biodiversity loss, climate change are all reminders of how connected we are. The recovery from this pandemic is an opportunity to put in place more effective policies, institutions, and resources to address biodiversity loss.Publication Economic Recovery(World Bank, Washington, DC, 2021-04-06)World Bank Group President David Malpass spoke about the world facing major challenges, including COVID, climate change, rising poverty and inequality and growing fragility and violence in many countries. He highlighted vaccines, working closely with Gavi, WHO, and UNICEF, the World Bank has conducted over one hundred capacity assessments, many even more before vaccines were available. The World Bank Group worked to achieve a debt service suspension initiative and increased transparency in debt contracts at developing countries. The World Bank Group is finalizing a new climate change action plan, which includes a big step up in financing, building on their record climate financing over the past two years. He noted big challenges to bring all together to achieve GRID: green, resilient, and inclusive development. Janet Yellen, U.S. Secretary of the Treasury, mentioned focusing on vulnerable people during the pandemic. Kristalina Georgieva, Managing Director of the International Monetary Fund, focused on giving everyone a fair shot during a sustainable recovery. All three commented on the importance of tackling climate change.Publication Media and Messages for Nutrition and Health(World Bank, Washington, DC, 2020-06)The Lao Peopleโs Democratic Republic (Lao PDR) has experienced rapid and significant economic growth over the past decade. However, poor nutritional outcomes remain a concern. Rates of childhood undernutrition are particularly high in remote, rural, and upland areas. Media have the potential to play an important role in shaping health and nutritionโrelated behaviors and practices as well as in promoting sociocultural and economic development that might contribute to improved nutritional outcomes. This report presents the results of a media audit (MA) that was conducted to inform the development and production of mass media advocacy and communication strategies and materials with a focus on maternal and child health and nutrition that would reach the most people from the poorest communities in northern Lao PDR. Making more people aware of useful information, essential services and products and influencing them to use these effectively is the ultimate goal of mass media campaigns, and the MA measures the potential effectiveness of media efforts to reach this goal. The effectiveness of communication channels to deliver health and nutrition messages to target beneficiaries to ensure maximum reach and uptake can be viewed in terms of preferences, satisfaction, and trust. Overall, the four most accessed media channels for receiving information among communities in the study areas were village announcements, mobile phones, television, and out-of-home (OOH) media. Of the accessed media channels, the top three most preferred channels were village announcements (40 percent), television (26 percent), and mobile phones (19 percent). In terms of trust, village announcements were the most trusted source of information (64 percent), followed by mobile phones (14 percent) and television (11 percent). Hence of all the media channels, village announcements are the most preferred, have the most satisfied users, and are the most trusted source of information in study communities from four provinces in Lao PDR with some of the highest burden of childhood undernutrition.Publication South Asia Development Update, April 2024: Jobs for Resilience(Washington, DC: World Bank, 2024-04-02)South Asia is expected to continue to be the fastest-growing emerging market and developing economy (EMDE) region over the next two years. This is largely thanks to robust growth in India, but growth is also expected to pick up in most other South Asian economies. However, growth in the near-term is more reliant on the public sector than elsewhere, whereas private investment, in particular, continues to be weak. Efforts to rein in elevated debt, borrowing costs, and fiscal deficits may eventually weigh on growth and limit governments' ability to respond to increasingly frequent climate shocks. Yet, the provision of public goods is among the most effective strategies for climate adaptation. This is especially the case for households and farms, which tend to rely on shifting their efforts to non-agricultural jobs. These strategies are less effective forms of climate adaptation, in part because opportunities to move out of agriculture are limited by the regionโs below-average employment ratios in the non-agricultural sector and for women. Because employment growth is falling short of working-age population growth, the region fails to fully capitalize on its demographic dividend. Vibrant, competitive firms are key to unlocking the demographic dividend, robust private investment, and workersโ ability to move out of agriculture. A range of policies could spur firm growth, including improved business climates and institutions, the removal of financial sector restrictions, and greater openness to trade and capital flows.Publication The Journey Ahead(Washington, DC: World Bank, 2024-10-31)The Journey Ahead: Supporting Successful Migration in Europe and Central Asia provides an in-depth analysis of international migration in Europe and Central Asia (ECA) and the implications for policy making. By identifying challenges and opportunities associated with migration in the region, it aims to inform a more nuanced, evidencebased debate on the costs and benefits of cross-border mobility. Using data-driven insights and new analysis, the report shows that migration has been an engine of prosperity and has helped address some of ECAโs demographic and socioeconomic disparities. Yet, migrationโs full economic potential remains untapped. The report identifies multiple barriers keeping migration from achieving its full potential. Crucially, it argues that policies in both origin and destination countries can help maximize the development impacts of migration and effectively manage the economic, social, and political costs. Drawing from a wide range of literature, country experiences, and novel analysis, The Journey Ahead presents actionable policy options to enhance the benefits of migration for destination and origin countries and migrants themselves. Some measures can be taken unilaterally by countries, whereas others require close bilateral or regional coordination. The recommendations are tailored to different types of migrationโ forced displacement as well as high-skilled and low-skilled economic migrationโand from the perspectives of both sending and receiving countries. This report serves as a comprehensive resource for governments, development partners, and other stakeholders throughout Europe and Central Asia, where the richness and diversity of migration experiences provide valuable insights for policy makers in other regions of the world.