Attraction and Retention of Rural Primary Health-care Workers in the Asia Pacific Region
How to Cite this publication
Liu X, Zhu A and Tang S. Attraction and Retention of Rural Primary Health-care Workers in the Asia Pacific Region. New Delhi: World Health Organization, Regional Office for South-East Asia, 2018.
Maldistribution of Health-care workers is a serious concern in the Asia Pacific Region, which results in poor availability of health services and negative health outcomes particularly for vulnerable populations in rural and remote areas. Given that many countries has been experiencing rapid economic growth despite large variations in socioeconomic and health system characteristics, examining how the changes in health systems especially health financing reform and private health sector development affect strengthening HRH can contribute to our knowledge and provide useful lessens for the region and other countries.
In this policy brief, mixed methods of systematic review of the literature and case studies from three Asian countries (Cambodia, China and Viet Nam) were undertaken to explore the interventions on the attraction and retention of rural health workers in the Asia Pacific region.
Systematic review identified four types of interventions including 1) Educational and training interventions, 2) Regulatory interventions, 3) Interventions providing financial incentives, and 4) Interventions providing personal and professional support, while country case studies based on key informant interviews identified that interventions depended on the socioeconomic status among and within countries. However all three countries have bundles of interventions including all or part of four types of intervention identified by systematic review as a strategy, especially financial incentives and personal and professional support were used in all countries.
In most cases, central governments were responsible for developing key interventions while regional health institution took the responsibility for their implementation under national guidance. Some regional initiatives were seen to strengthen the local health workforce by offering financial incentives and better living condition. Also universities were significant stakeholders in capacity-building of the rural health workforce through medical education and training in some countries in collaboration with central or regional government.
The effectiveness of the interventions varied according to the intervention and country. While most of the evaluated interventions were found to be effective in the systematic review, effectiveness varied among different interventions in country case studies, this could be because of the publication bias. Also difference context such as political, economic and social issues, and health system-related factors would often affect the implementation and effectiveness of interventions.
The policy brief concludes with five policy implications and recommendations.
1. A systematic contextual analysis to be conducted when designing, implementing and evaluating interventions.
2. Engagement of local authorities in formulating a local HRH plan
3. Interventions to be integrated into an overall health system reform.
4. Monitoring and evaluation (M&E) and performance/output indicators for M&E should be included in the overall study design.
5. A platform for mutual learning may be established to promote communication/exchange of information in the Asia Pacific region.