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Rural recruitment and retention of health workers across cadres and types of contract in north-east India: a qualitative study / Preety R Rajbangshi;Devaki Nambiar;Nandini Choudhury;Krishna D Rao

Tác giả : Preety R Rajbangshi;Devaki Nambiar;Nandini Choudhury;Krishna D Rao

Nhà xuất bản : World Health Organization. Regional Office for South-East Asia

Năm xuất bản : 2017

Chủ đề : 1. contractual health workers. 2. health workers. 3. India. 4. permanent health workers. 5. rural recruitment. 6. rural retention. 7. Journal / periodical articles.

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Background Like many other low- and middle-income countries, India faces challenges of recruitingand retaining health workers in rural areas. Efforts have been made to address this through contractualappointment of health workers in rural areas. While this has helped to temporarily bridge the gaps in humanresources, the overall impact on the experience of rural services across cadres has yet to be understood.This study sought to identify motivations for, and the challenges of, rural recruitment and retention of nurses,doctors and specialists across types of contract in rural and remote areas in India’s largely rural north-easternstates of Meghalaya and Nagaland.Methods A qualitative study was undertaken, in which 71 semi-structured interviews were carried out withdoctors (n = 32), nurses (n = 28) and specialists (n = 11). In addition, unstructured key informant interviews(n = 11) were undertaken, along with observations at health facilities and review of state policies. Datawere analysed using Ritchie and Spencer’s framework method and the World Health Organization’s 2010framework of factors affecting decisions to relocate to, stay in or leave rural areas.Results It was found that rural background and community attachment were strongly associated withhealth workers’ decision to join rural service, regardless of cadre or contract. However, this aspiration waschallenged by health-systems factors of poor working and living conditions; low salary and incentives; andlack of professional growth and recognition. Contractual health workers faced unique challenges (lack of payparity, job insecurity), as did those with permanent positions (irrational postings and political interference).Conclusion This study establishes that the crisis in recruiting and retaining health workers in rural areaswill persist until and unless health systems address the core basic requirements of health workers in ruralareas, which are related to health-sector policies. Concerted attention and long-term political commitmentto overcome system-level barriers and governance may yield sustainable gains in rural recruitment andretention across cadres and contract types.

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https://iris.who.int/handle/10665/329622