Rural/Urban Imbalance

This text describes how rural health professionals and rural communities are currently working towards healthy communities. Significant rural issues are analysed with regard to professional practice and personal lifestyles, as well as how these issues could be addressed by innovative future practice or how they present challenges for learning or teaching. [adapted from author]

This paper aims to examine equity of utilisation of general practitioner services in Australia, particularly those living in remote or rural areas. [from abstract]

This report presents an overview of outreach services provided by health workers to remote and rural populations in different countries and contexts. It highlights the potential for alternative health service delivery models, such as mobile clinics and telemedicine, to enhance the attraction and retention of health workers in underserved areas. [from preface]

This technical report presents the results of a discrete choice experiment (DCE) conducted by the Lao People’s Democratic Republic Ministry of Health, in partnership with the World Health Organization and CapacityPlus, using CapacityPlus’s rural retention survey toolkit. The DCE surveyed health professional students and health workers practicing in rural provinces to investigate their motivational preferences for potential strategies to increase attraction and retention in the country’s rural and remote settings. [from publisher]

The focus of this brief is on nurses’, clinical officers’ and assistant medical officers’ job preferences and their willingness to work in rural and remote areas in Tanzania. [from author]

The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana including salary, infrastructure, management style, and contract length in considering future jobs. [from author]

In this study, the authors analyze the trends in the geographic disparities of population and physician distribution among the secondary tier of medical care in Japan. [adapted from author]

This paper presents results of an empirical study conducted in Liberia and Vietnam using a discrete choice experiment (DCE) which aimed to predict the likelihood of health workers taking up a rural area job under alternative incentive schemes.

This issue of Voices describe an effort to assess health workers’ preferences in order to determine the most effective incentives for rural service. [adapted from author]

Many countries, including Vietnam, are debating the right mix of interventions to motivate doctors in particular to work in remote areas. The objective of this study was to understand the dynamics of the health labour market in Vietnam, and what might encourage doctors to accept posts and remain in-post in rural areas. [from abstract]

This paper assesses the influence of intrinsic and extrinsic motivation on willingness to accept postings to deprived areas among medical students in Ghana. [from abstract]

The purpose of this study was to report on the preparedness of medical students and junior doctors to commit to working in areas of workforce shortage. [from abstract]

For more than 25 years, family medicine residencies have worked with community health centers (CHCs) to train family physicians. This study compares CHC and non-CHC-trained family physicians regarding practice location, job and training satisfaction, and recruitment and retention to underserved areas. [from author]

This article proposes the idea of a new degree course in medicine of a shorter duration to encourage students from rural areas to take up medicine and then provide services in their local areas. [from author]

This article describes an innovative strategy to test a health human resource (HHR) planning and employment model to foster inter-organizational collaboration, knowledge transfer and exchange of nurses between an urban academic health science centre and a remote region in northern Ontario. [from introduction]

This qualitative study was undertaken to understand how practicing doctors and medical leaders in Ghana describe the key factors reducing recruitment and retention of health professionals into remote areas, and to document their proposed policy solutions. [from abstract]

The reported study sought the views of mental health organisation leaders from Gippsland to identify current approaches and potential solutions to the challenges of workforce recruitment, retention and training in rural areas. [from abstract]

This report discusses and analyzes labor market dynamics and outcomes (including unemployment, worker shortages, and urban-rural imbalances of categories of health workers) from a labor economics perspective to address undesirable outcomes (including urban-rural HRH imbalances) more effectively. [adapted from summary]

This article discusses Thailand’s mandatory health service system. Under this system, all early-career health workers from public professional schools serve in rural areas as a governmental worker to maintain the rural health workforce. The system has ameliorated the shortage of physicians in rural areas by substantially decreasing the emigration of Thai physicians to foreign countries.

This paper reviews the evidence on costing interventions to improve health workforce recruitment and retention in remote and rural areas, provides guidance to undertake a costing evaluation of such interventions and investigates the role and importance of costing to inform the broader assessment of how to improve health workforce planning and management. [from abstract]

This study aimed to evaluate the influence of educational factors on the choice of rural or urban sites of practice of health professionals in South Africa. [from abstract]

This study aimed to determine factors that will attract and retain rural and urban health workers to rural Nigerian communities, and to examine differences between the two groups. [from abstract]

The objective of this study was to assess the influence of loan repayment and other factors on the recruitment and retention of healthcare providers in rural Colorado, USA, and to compare the motivations and attitudes of these rural providers with their urban counterparts. [from introduction]

This article describes the National Rural Health Mission of India and the initiatives undertaken to address the lack of skilled service providers in rural areas including an increase in sanctioned posts for public health facilities, incentives, workforce management policies, locality-specific recruitment and the creation of a new service cadre specifically for public sector employment. [adapted from abstract]

This article describes a program directed at the re-supply of rural physicians in rural areas and its success in addressing the critical shortages caused by maldistribution of health care workers. [adapated from abstract]

Kenya has bold plans for scaling up priority interventions nationwide, but faces major human resource challenges, with a lack of skilled workers especially in the most disadvantaged rural areas. This study investigated reasons for poor recruitment and retention in rural areas and potential policy interventions through quantitative and qualitative data collection with nursing trainees. [adapted from abstract]

Several training institutions have engaged in programs to expose pre-service health workers to rural health work to demystify it and to enable the professionals make an informed choice on practice location after qualification. In this study, the intentions of Ugandan medical students to work in rural health facilities after qualification were sounded out, together with the factors that affect them and their perception of rural areas. [from abstract]

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. [from abstract]

Retention of GPs in the more remote parts of Australia remains an important issue in workforce planning. The Northern Territory of Australia experiences very high rates of staff turnover. This research examined how the process of forming place attachment between GP and practice location might influence prospects for retention. [from abstract]

Positive learning experiences for students on clinical placement in rural settings have the potential for supporting the recruitment of qualified nurses to these areas. Recruitment of such nurses is a global concern because current shortages have resulted in decreased healthcare quality for rural residents. By understanding the challenges faced by nursing students unfamiliar with rural settings, educational and organizational strategies can be developed to promote positive learning experiences and so enhance recruitment.