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Staffing remote rural areas in middle- and low-income countries : a literature review of attraction and retention

Document type: article
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Abstract: Many countries in middle- and low-income countries today suffer from severe staff shortages and/or maldistribution of health personnel which has been aggravated more recently by the disintegration of health systems in low-income countries and by the global policy environment. One of the most damaging effects of severely weakened and under-resourced health systems is the difficulty they face in producing, recruiting, and retaining health professionals, particularly in remote areas. Low wages, poor working conditions, lack of supervision, lack of equipment and infrastructure as well as HIV and AIDS, all contribute to the flight of health care personnel from remote areas. The development of appropriate strategies first requires an understanding of the factors which influence decisions to accept and/or stay in a remote post, particularly in the context of mid and low income countries (MLICS), and which strategies to improve attraction and retention are therefore likely to be successful. It is the aim of this review article to explore the links between attraction and retention factors and strategies, with a particular focus on the organisational diversity and location of decision-making. This literature review focused on English-language material published between 1997 and 2007. The authors conducted Pubmed searches using a range of different search terms relating to attraction and retention of staff in remote areas. Furthermore, a number of relevant journals as well as unpublished literature were systematically searched. About 600 papers were initially assessed and 55 eventually included in the review. There is a strong argument to be made for bundles of interventions which include attention to living environments, working conditions and environments and development opportunities. The paper provides a simple framework for bringing the key decision-makers together to identify factors and develop multi-facetted comprehensive strategies.
Authors: Lehmann, U. , Dieleman, M. , Martineau, T.
Category: Policy
Volume: 8
Journal: BMC Health Services Research
Keywords: health services , human resource management
Language: eng
Organization: KIT - Royal Tropical Institute
Year: 2008
Right: © 2008 Lehmann et al. This work is licensed under a Creative Commons Attribution License.
Subject: Health and Nutrition
Title: Staffing remote rural areas in middle- and low-income countries : a literature review of attraction and retention