From one-district-one-doctor to the inclusive track: Lessons learned from a 12-year special recruitment program for medical education in Thailand.

Abstract

The One-District-One-Doctor (ODOD) medical education program was launched in 2005 with the purpose of increasing the production of rural doctors through special recruitment in Thailand. This article provides details of the ODOD program, together with its successes and challenges. Comparisons of the applied interventions between ODOD, the conventional rural recruitment program (Collaborative Project to Increase Production of Rural Doctors [CPIRD]), and the Inclusive track are also described. Compared with the CPIRD program, additional interventions are applied to the ODOD program, including (1) recruitment from remote rural areas; (2) subsidized education in return for service; and (3) extended compulsory service in rural areas with a higher penalty fine. While ODOD students have shown a relatively high rural retention rate, the program challenges include low admission rate, adverse consequences from an extended compulsory service, restriction on specialist training, and high penalty fee. As a consequence of the program interventions, another special medical education program, the Inclusive track, was introduced as a replacement. Strategies through the Inclusive track to recruit students from remote rural areas are similar to those of ODOD. However, unlike ODOD, the Inclusive track has a reduced duration of compulsory service and penalty fine to match those of the standard requirements in the Normal track and CPIRD students. Building on past experience, the Inclusive track pursues a balance of pros and cons from the other medical production programs. Program evaluation and close monitoring will be crucial to measure the feedback from the Inclusive track to further improve the sustainability of long-term retention of rural physicians.