Abstract
IntroductionThe shortage and maldistribution of health care workers in sub-Saharan Africa is a major concern for rural health facilities. Rural areas have 63% of sub-Saharan Africa population but only 37% of its doctors. Although attrition of health care workers is implicated in the human resources for health crisis in the rural settings, few studies report attrition rates and risk factors for attrition in rural district hospitals in sub-Saharan Africa.MethodsWe assessed attrition of health care workers at a Kirehe District Hospital in rural Rwanda. We included all hospital staff employed as of January 1, 2013 in this retrospective cohort study. We report the proportion of staff that left employment during 2013, and used a logistic regression to assess individual characteristics associated with attrition.ResultsOf the 142 staff employed at Kirehe District Hospital at the start of 2013, 31.7% (n=45) of all staff and 81.8% (n=9) of doctors left employment in 2013. Being a doctor (OR=10.0, 95% CI: 1.9-52.1, p=0.006) and having up to two years of experience at the hospital (OR=5.3, 95% CI: 1.3-21.7, p=0.022) were associated with attrition.ConclusionKirehe District Hospital experienced high attrition rates in 2013, particularly among doctors. Opportunities for further training through Rwanda’s Human Resources for Health program in 2013 and a two-year compulsory service program for doctors that is not linked to interventions for rural retention may have driven these patterns. Efforts to link these programs with rural placement and retention strategies are recommended.
Highlights
The shortage and maldistribution of health care workers in sub-Saharan Africa is a major concern for rural health facilities
Sub-Saharan Africa, which bears a quarter of the global disease burden [4] and has 63% of her population living in rural settings [6], only has 3% of the world’s trained health workforce [4] with 37% of doctors and 49% of nurses and midwives working in the rural areas [7]
With little known about health worker attrition in rural Rwanda, our study evaluated the rates and individual factors associated with attrition at a rural district hospital in the setting of a two-year compulsory service and the Human Resources for Health program
Summary
The shortage and maldistribution of health care workers in sub-Saharan Africa is a major concern for rural health facilities. Attrition of health care workers is implicated in the human resources for health crisis in the rural settings, few studies report attrition rates and risk factors for attrition in rural district hospitals in subSaharan Africa. Opportunities for further training through Rwanda’s Human Resources for Health program in 2013 and a two-year compulsory service program for doctors that is not linked to interventions for rural retention may have driven these patterns. Sub-Saharan Africa, which bears a quarter of the global disease burden [4] and has 63% of her population living in rural settings [6], only has 3% of the world’s trained health workforce [4] with 37% of doctors and 49% of nurses and midwives working in the rural areas [7]. Rwanda implemented some of these initiatives including a compulsory service program for newly graduate doctors that began in 2010, and required two years of service at district hospitals after receiving medical practice license
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