Health Workforce In Rural Areas Research Articles

Evaluation of a medical education policy with compulsory rural service in China.

Since 2010, China has implemented a national programme to train general practitioners for rural areas. The programme enrolled medical students with a rural background who signed a contract for 6 years' compulsory rural service after graduation. China is transitioning its national COVID-19 strategies in view of the features of coronavirus Omicron variant, the vaccination coverage, and the need for socioeconomic development. Strengthening primary health care, especially the health workforce in rural areas, should be an important consideration during the policy transition. This study aims to evaluate the implementation process of enrolling medical students in the programme, their willingness to work in the rural settings and their actual job choice after graduation. The study chose four medical universities in central and western China. A total of 2,041 medical graduates who have signed a contract for compulsory rural service and 1,576 medical graduates enrolled "as usual" (no compulsory rural service) were recruited in five campaigns-every June from 2015 to 2019. A survey was conducted 1 week before their graduation ceremony. The top three reasons for choosing this programme were: a recommendation of a family member or teacher, a guaranteed job after graduation and the waiver of the tuition fee. 23.0-29.7% of the study participants were not familiar with the policy details. 39.1% of the medical students signed a contract with a county other than that of their hometown. Medical graduates on the compulsory rural service programme had very low willingness (1.9%) to work in rural areas but 86.1% of them actually worked at township health centers. In contrast, the willingness to work at township health centers was 0.2% for the comparison group (medical graduates without the contract), and their actual job choice at township health centers was 0%. Although the well-trained medical graduates on the compulsory rural service programme have low willingness to work in the township health centers, 86.1% of them choose to do so following their contract. This programme will strengthen the primary health workforce to deal with the increasing disease burden as China is transitioning its national COVID-19 strategies.

Accommodate or Reject: The Role of Local Communities in the Retention of Health Workers in Rural Tanzania.

Background: While over 70% of the population in Tanzania reside in rural areas, only 25% of physicians and 55% of nurses serve these areas. Tanzania operates a decentralised health system which aims to bring health services closer to its people through collaborative citizen efforts. While community engagement was intended as a mechanism to support the retention of the health workforce in rural areas, the reality on the ground does not always match this ideal. This study explored the role local communities in the retention of health workers in rural Tanzania. Methods: An exploratory qualitative study was completed in two rural districts from the Kilimanjaro and Lindi regions in Tanzania between August 2015 and September 2016. Nineteen key informant interviews (KIIs) were conducted with district health managers, local government leaders, and health facility in-charges. In addition, three focus group discussions (FGDs) were conducted with 19 members of the governing committees of three health facilities from the two districts. Data were analysed using the thematic analysis technique. Results: Accommodation or rejection were the two major ways in which local communities influenced the quest for retaining health workers. Communities accommodated incoming health workers by providing them a good reception, assuming responsibility for resolving challenges facing health facilities and health workers, linking health workers to local communities and promoting practices that placed a high value on health workers. On the flip side, communities could also reject health workers by openly expressing lack of trust and labelling them as ‘foreigners,’ by practicing cultural rituals that health workers feared and discrimination based on cultural differences. Conclusion: Fostering good relationships between local communities and health workers may be as important as incentives and other health system strategies for the retention of health workers in rural areas. The role communities play in rural health worker retention is not sufficiently recognized and is worthy of further research.

Personal resilience and rural doctors retention: a study in Indonesia.

Retaining the health workforce in rural areas is a global problem. Job dissatisfaction or work-related distress are among the factors that drive doctors to leave rural places. Resilience has been recognised as a key component of wellbeing and is associated with better satisfaction with life. Building personal resilience has the benefits of lowering vulnerability to work-related adversity. This study examined the association between rural doctors' personal resilience and the duration of rural practice. This cross-sectional study was set in a rural province in Indonesia. A total sampling procedure was implemented. A total of 528 participants responded to an online survey. The survey tool measured six dimensions of a resilience profile &#40;determination, endurance, adaptability, recuperability, comfort zone and life calling&#41; and collected personal data such as date of birth, practice location and duration of rural practice experience. These participants were classified into four groups: intern, general (GP) with 10 years experience. The data were analysed quantitatively using Oneway analysis of variance (ANOVA). Doctors with longer durations of rural experience showed higher resilience levels in four of the dimensions of personal resilience: endurance, adaptability, recuperabilit&shy;y and comfort zone. Among those four dimensions, endurance and comfort zone showed significant differences between groups with >10 years of difference in rural experience (p<0.05). The other two dimensions, determination and life calling, showed fluctuations across groups with different rural durations. This study provides a preliminary result for understanding the relationship between personal resilience and rural doctor retention. It suggests that resilience is partly associated with rural doctor retention. Further studies are needed to examine the causal relationship between resilience and retention.

Professional identity and mental health of rural-oriented tuition-waived medical students in Anhui Province, China

BackgroundThe shortage of primary care physicians in rural China is an enduring problem with serious implications for access to care. In response to the shortage in health workforce in rural areas, China government has launched the rural-oriented tuition-waived medical education (RTME) programme since 2010, aiming to train more general practitioners to address the rural health workforce requirements in middle and west areas. This study aims to investigate the prevalence of mental illness and the level of professional identity in the rural-oriented tuition-waived medical students (RTMSs), and to explore the impact of the RTMSs’ professional identity and related cognition and satisfaction with the RTME programme on mental health.MethodsWe conducted a descriptive, cross-sectional study. A total of 1103 RTMSs and 1095 non-oriented medical students from seven medical universities (colleges) in Anhui province completed a demographic questionnaire, the Depression, Anxiety, Stress Scales and the Professional Identity Questionnaire for Undergraduate Students. Cognition and satisfaction with the RTME programme of the RTMSs were collected. Multiple linear regression analysis was used to analyze the data.ResultsThe prevalence of depression, anxiety, and stress in RTMSs were 11.8, 22.9 and 3.4%, respectively. The mean total scores of the Professional Identity Questionnaire for Undergraduate Students were 3.58 (SD = 0.61). Results of multiple linear regression model indicated that students who are dissatisfied with targeted primary healthcare institution are likely to suffer from depression and anxiety; moreover, students who enrolled in the rural-oriented tuition-waived medical education programme due to economic reason are more likely to suffer from anxiety. Furthermore, a significant positive correlation was found between professional identity and mental health.ConclusionsProviding better information about the RTME programme prior to enrollment and improving the students’ cognition of the policy’s effectiveness and the social value of rural healthcare work may contribute to improving the professional identity of the RTMSs. Meanwhile, a significant positive association was found between professional identity and mental health. This is a new perspective that shows that developing and improving professional identity may help medical students reduce the risk of psychological illness.

Job Preferences of Doctors for Working in Rural Islamabad Capital Territory, Pakistan: a Discrete Choice Experiment

Background: Developing countries are facing acute shortage of human resource in rural/remote areas. Effective management and retention of human resource for health are related to efficient financing and lucrative incentives packages. This study focused on preferred incentives of doctors for working in rural and resource constrained areas of Pakistan. Methods: This study was a Discrete Choice Experiment (DCE). Study population (N=107) included final year medical student and fresh graduated doctors in Islamabad. Questionnaire was computer based and data was collected through online database. Results were analyzed using conjoint analysis technique on Stata 11.0 to present the findings. Results: The results showed that mostly young doctors do not prefer to work in rural areas. Preference to opt for rural job posting depended largely on high salary along with study assistance for further education. Other attributes identified as attracting and retaining young doctors for rural job posting included career advancement, improved quality of health facilities, provision of housing allowance and transportation. Conclusion: Study results showed that salary is not the only deciding factor for attracting and retaining health workforce in rural areas. Further education for highly valued and the government should focus on efficient use of available budget to develop a bundle of cadre specific incentives package to attract and retain HR in rural and underserved areas.

The educational sector; the possible ally to attract and retain health workforce in rural areas

The educational sector; the possible ally to attract and retain health workforce in rural areas

Factors behind job preferences of Peruvian medical, nursing and midwifery students: a qualitative study focused on rural deployment.

BackgroundDeployment of health workforce in rural areas is critical to reach universal health coverage. Students’ perceptions towards practice in rural areas likely influence their later choice of a rural post. We aimed at exploring perceptions of students from health professions about career choice, job expectations, motivations and potential incentives to work in a rural area.MethodsIn-depth interviews and focus groups were conducted among medical, nursing and midwifery students from universities of two Peruvian cities (Ica and Ayacucho). Themes for assessment and analysis included career choice, job expectations, motivations and incentives, according to a background theory a priori built for the study purpose.ResultsPreference for urban jobs was already established at this undergraduate level. Solidarity, better income expectations, professional and personal recognition, early life experience and family models influenced career choice. Students also expressed altruism, willingness to choose a rural job after graduation and potential responsiveness to incentives for practising in rural areas, which emerged more frequent from the discourse of nursing and midwifery students and from all students of rural origin. Medical students expressed expectations to work in large urban hospitals offering higher salaries. They showed higher personal, professional and family welfare expectations. Participants consistently favoured both financial and non-financial incentives.ConclusionsNursing and midwifery students showed a higher disposition to work in rural areas than medical doctors, which was more evident in students of rural origin. Our results may be useful to improve targeting and selection of undergraduate students, to stimulate the inclination of students to choose a rural job upon graduation and to reorient school programmes towards the production of socially committed health professionals. Policymakers may also consider using our results when planning and implementing interventions to improve rural deployment of health professionals.

Community health practitioner’s practice guideline for a changing health care: Korean contribution

The specific aims of the study were (1) to identify community residents' health problems and community health practitioners' activities, (2) to explore community health practitioners' perception of the practice guidelines and (3) to provide recommendations for the development of a new practice guideline in the future. Community health practitioners in Korea are recognised as a critical component of the public health workforce in rural areas. Community health practitioners are registered nurses with six months special training, who have the chief responsibility of delivering primary health care to remote or isolated communities. Although there has been numerous changes in focus of community health practitioners practice over the two decades, community health practitioners guidelines have never been updated since being first developed in 1981. This investigation employed a cross-sectional survey and focus group interview. The samples included two different groups: 1003 community health practitioners participated in a survey and a group of 12 community health practitioners participated in a focus group interview. A measure of perception of the guideline was developed from Mansfield's work. Goolsby's criteria were revised and used to guide the focus group interview. The participants recognised that the role of community health practitioners is in a process of transition and expect to use well developed guidelines that will allow an appropriate response to the needs of the community. Community health practitioners are generally supportive of practice guidelines although they report various contextual, social and resource barriers to the use of practice guidelines. Finally, the researchers have provided recommendations for the development of new community health practitioners practice guidelines. A newly developed community health practitioners guideline should assist in articulating new roles and responsibilities in the practice of community health practitioners and establish a foundation for knowledge, skills and training necessary for them to work independently. New services made available for under-recognised health problems may be a direct outcome of newly developed guidelines.