Rural/Urban Imbalance

In 1989, the government of Indonesia launched the Midwife in the Village programme. Its purpose was to reduce maternal death by assigning a resident midwife to each village in the country. By definition, she would live in the village and be part of the community she served. In 2005, Immpact examined the effect of the programme on the health and survival of mothers in two districts in Java. [from author’s description]

This paper examines the design and limitations of incentives for health care providers to serve in rural areas in developing countries. [from summary]

Through its Community-Based Health Planning and Services (CHPS) initiative, Ghana has deployed more than 310 auxiliary nurses in 53 of the country’s most deprived districts. These nurses, who receive two years of training and the title Community Health Officer (CHO), are part of an innovative approach that shifts staff from low-impact static health centers with limited outreach to high-impact mobile community-supported services. CHOs provide doorstep services to underserved rural populations and have improved access to health services for nearly one million Ghanaians (each CHO serves an average of 4,500 people), resulting in substantial improvements in community health.

The report provides evidence of inadequate ratios of personnel to population for key skilled health personnel, and a maldistribution of personnel along three different axes, between: public and private heath sectors, urban and rural areas and tertiary and primary levels of the health system. It describes the exodus of healthcare workers from areas of poverty and low socio-economic development, to more highly developed areas. [from executive summary]

South African citizens have experienced many inequalities and these have extended to the health care setting. one of the major challenges that needs to be addressed is the accessibility and availability of health care and specialized medical services in rural areas in South Africa. Telemedicine is a potential solution to address some of the challenges within health care in a developing country like South Africa. This article looks at the experiences of developing and implementing a telemedicine solution. [abstract]

The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians’ and managers’ perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. [abstract]

In South Africa, the distribution of doctors is skewed in favour of the urban areas, but it is not uncommon to find many peri-urban facilities in short supply of doctors. In 1997, the South African government introduced compulsory community service (CS) to address this uneven distribution of doctors in the country. The CS doctors posted to the Letaba-Sekororo hospital complex in Limpopo Province refused to take up their appointments for various reasons, ranging from lack of supervision to poor basic infrastructure. This study is one of the earliest conducted to understand the perceptions of hospital managers on the impact of the national community service on the health service. [publisher’s description]

This Kenya assessment is part of a multicountry initiative to provide data and options to policymakers and donors amidst for building the capacity of health care systems in low resource countries through recruitment, training, and deployment of public and private health workers. The assessments look at how human resource (HR) policy and workload planning can address personnel shortages, specifically, gross imbalances across urban and rural areas and among personnel categories, including doctors, nurses, pharmacists, and lab technicians. [adapted from author]

Maldistribution of human resources for health is a worldwide phenomenon and may appear in different dimensions. The first and greatest concern is the inequitable distribution, particularly of high level professionals like doctors, both among countries in the world and within each country. [author’s description]

The maintenance of competence by rural district hospital medical practitioners is a challenge faced by all countries and, most acutely, by resource-poor nations. It is a vital element in addressing the disparity between rural and urban health care in South Africa. The aim of this study was to define expert consensus on the content and methods most suitable for the maintenance of competence by rural district hospital practitioners in the Western Cape province of South Africa. [author’s description]

Health service managers in the Western Cape requested a skills audit of medical officers in district hospitals to identify a possible gap in competencies that may impact on service delivery. The aim of this study was thus to identify the knowledge and skills of medical practitioners delivering these services in the Western Cape and to compare them with service needs in order to make recommendations for education and training. This article reports on the results of the knowledge and skills gap analysis, while the results of the district hospital performance data and in-depth interviews are reported elsewhere.

The Department of Health in South Africa has attempted to address the shortage of rural doctors by introducing various interventions, including an increase in salaries, introduction of scarce skills and rural allowances, the deployment of foreign doctors, and upgrading of clinics and hospitals. Despite these, the maldistribution of doctors working in South Africa has not improved significantly. The main objectives of this study were to identify interventions as proposed by doctors in the rural Limpopo province of South Africa and to develop recommendations based on these. [from introduction]

There is compelling evidence for the success of the “rural pipeline” (rural student recruitment and rurally based education and professional training) in increasing the rural workforce. The nexus between clinical education and training, sustaining the health care workforce, clinical research, and quality and safety needs greater emphasis in regional areas.

Against the backdrop of growing concern about shortages of health personnel, the report focuses on one of the most critical components of the workforce

This paper reviews the situation and trend in human resources for health and its priority problems in Thailand. It also highlights the issue of the inequitable distribution of doctors. Through several brainstorming sessions among stakeholders, it summarizes a package of recommendations for the future continuous and sustainable knowledge-based human resources for health development. [from abstract]

The township health system in Myanmar is regarded as means to achieve the end of an equitable, efficient and effective health system based on the principles of primary health care approach. A township hospital caters medical care at the second referral level. Under the leadership and management of a Township Medical Officer in each township, para-professionals deployed at Rural Health Centers (RHCs) and Sub-centers under each RHC’s jurisdiction play key roles for providing primary health care services for rural population.

This document contains a country analysis on HRH covering situations, trends, and priority problems including issues in undifferentiated strategies of health sector development for remote areas and the shortage and maldistribution of well trained nurses and community nurses. It also includes a discussion on HRH development, strategies and policies in Lao PDR. [adapted from author]

This document report on the trends of HRH during past fifty years including the issues of unqualified doctors in rural areas, geographical differences in HRH, and the increase in medical school graduates. It also forecasts HRH needs for fifteen years from 2000 to 2015.

The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them.

Most human resources for health in developing countries are produced by highly subsidized public institutes. Due to inequity in basic education most health science students are from wealthier urban families. They tend to remain in urban areas after graduation, creating inequitable distribution of health personnel. At the same time the public education institutes are subject to strong bureaucratic inefficiency and usually no systematic quality control system. This paper analyses this situation in Thailand. [adapted from abstract]

This paper analyzes the present situation of general practitioners in the Thai health care system and the conditions under which their contribution could be strengthened. [from abstract]

Australia is experiencing workforce shortages across a number of health professions despite a significant and growing reliance on overseas trained health workers. The shortages are even more acute in rural and remote areas. It is critical to increase the efficiency and effectiveness of the available health workforce, and to improve its distribution. This report describes the Australian government’s objectives of developing a more sustainable and responsive health workforce while maintaining a commitment to high quality and safe health outcomes. A set of national workforce objectives are also proposed.

This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options. [from abstract]

The objective of this paper is to contribute to a better understanding of the issues related to imbalance through a critical review of its definition, nature and measurement techniques, as well as the development of an analytical framework. [author’s description]

For a health district to function, referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. [from abstract]

Imbalance in the health workforce is a major concern in both developed and developing countries. It is a complex issue that encompasses a wide range of possible situations. This paper aims to contribute not only to a better understanding of the issues related to imbalance through a critical review of its definition and nature, but also to the development of an analytical framework. [from abstract]

This study aims at analysing the impact of international service trade on the health care system, particularly in terms of human resources for health (HRH), using Thailand as a case study. [from abstract]

This pilot study focused on self-identified factors of nursing students who expressed an interest in rural practice post-graduation. The sample included students from the USA and Canada, who were enrolled in graduate and undergraduate programs of nursing, and were attending an international rural nursing conference. [From abstract]

UniNet is an Internet-based thematic network for a virtual community of users. It supports a virtual multidisciplinary community for physicians, focused on the improvement of clinical practice. This is a study of the effects of a thematic network such as UniNet on primary care medicine in a rural area, specifically as a platform of communication between specialists at the hospital and doctors in the rural area. [from abstract]

In 2003 the Network published a discussion paper reviewing available literature and identifying key issues in need of further work, which this paper summarizes. In Southern Africa there are inadequate ratios of personnel to population for key skilled health personnel. There are a variety of push and pull factors that impact on the movement of healthcare workers. A more rigorous policy analysis is needed to stimulate innovation and to avoid measures and incentives counteracting each other. It is important to provide clearer policy analysis on production of health workers, on availability and distribution, and on movement and migration.