Submission ID 131831
| Issue/Objective | The global shortage of skilled health workers is often most acutely felt in rural, remote, and hard-to-reach areas. Rural and remote health workers often receive limited resources, professional development opportunities, and organizational support, and to date, countries struggle to improve recruitment and retention without a monitoring and evaluation approach to inform real-time decision-making. Therefore, we aimed to develop an evidence-informed guide for key stakeholders to consult when implementing, monitoring and evaluating rural and remote health workforce interventions. |
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| Methodology/Approach | A scoping review of the peer-reviewed literature on the implementation of education, regulation, incentive and support strategies for developing, attracting, recruiting and retaining the rural and remote health workforce was conducted. The retrieved articles were screened and 74 articles considered eligible for inclusion. Data was extracted on the strategies implemented, health worker occupations targeted, implementation barriers and facilitators, and effectiveness of bundled strategies, drawing on the 'Exploration, Preparation, Implementation, Sustainment' and 'Context of Implementation of Complex Interventions' Frameworks. A targeted grey literature review of M&E Frameworks and interviews with country focal points were conducted. Subsequently, Johns Hopkins University, World Health Organization focal points, and Technical Experts used the key findings to co-design an Implementation, Monitoring and Evaluation guide. |
| Results | The guide will help local actors including health facility managers, district health officers, health professional training institutions, local NGOs, regulatory bodies and communities with designing, implementing and continuously improving the rural and remote health workforce. It is structured around an iterative intervention lifecycle framework of four phases: 1) Planning & scoping; 2) design/update; 3) implement & adjust; and 4) evaluate/learn/adapt. The guide states that planning rural and remote health workforce interventions requires robust health labour market analyses (HLMA) to understand health workforce needs. In India, a descriptive HLMA was conducted in a rural State to fully grasp health labour market challenges and found that vacancies in the public sector existed for various health occupations, including specialists and nurses. Since the HLMA, 4,547 health workers including 1,141 doctors were recruited and vacancies were reduced to less than 20%. Another important recommendation of the guide is to design interventions through systematic and sustained engagement of local implementers and beneficiaries. In Guinea, for example, interviews were conducted with health facility managers, health workers, and community leaders to evaluate the relevance and feasibility of strategies for tackling rural absenteeism. Stakeholders proposed key strategies like local recruitment, strengthened supervision, local allocation of wages, and adopting career and training plans for health workers in rural areas. Implementing bundles of education, regulation, incentives, and support strategies while monitoring and evaluating them to ensure progress and timely adaptation is also highlighted in the guide as crucial. In Thailand, the government launched various retention schemes and conducted cohort studies to evaluate the long-term impact of education subsidies and compulsory service on rural doctor retention. Evaluations revealed that by 2015, the retention rate for CPIRD doctors in rural hospitals was 29%, notably higher than the 18% retention rate for those from traditional tracks and the average length of stay in rural settings was also greater - 4.2 years compared to 3.4 years for their counterparts. |
| Discussion/Conclusion | The guide aims to promote rural/remote health workforce interventions that systematically plan interventions to address gaps in the local health labour market context, engage local actors in intervention design to validate feasibility and relevance of interventions, and conduct monitoring and evaluation during implementation to foster continuous learning and adaptation. It encourages the use of local evidence and co-design with communities and health workers, because health worker decisions to stay in rural and remote areas are deeply rooted in the personal and professional context. It is important that implementation is documented for all phases in the intervention lifecycle to gain a more comprehensive understanding of how rural/remote health workforce recruitment and retention can be sustained over time. |
| Presenters and Affiliations | Youri P. Moleman Johns Hopkins Bloomberg School of Public Health Svea Closser Johns Hopkins Bloomberg School of Public Health Laurence Codjia World Health Organization Pascal Zurn World Health Organization Sheri Morgan Johns Hopkins Bloomberg School of Public Health Mohammed Gazali Salifu Johns Hopkins Bloomberg School of Public Health Maryam Hameed Khan Johns Hopkins Bloomberg School of Public Health Arman Majidulla Johns Hopkins Bloomberg School of Public Health Kirthini Muralidharan Johns Hopkins Bloomberg School of Public Health Krishna Rao Johns Hopkins Bloomberg School of Public Health Ligia Paina Johns Hopkins Bloomberg School of Public Health |
