Funding Agency: WHO Alliance for Health Policy and System Research

Fund: 39,890 USD

Principal Investigator: Dr. Liu Xiaoyun

Research Period: 31/03/2011-31/03/2012

Severe shortage and mal-distribution of health workers is a key challenge in Human Resources for Health (HRH) in many developing countries. Attraction and retention of health workers in remote and rural areas are determined by many factors including financial incentive, career development opportunities, recognition and appreciation by managers, colleagues, and communities. Various interventions have been implemented in many countries to improve attraction and retention of health workers. The most commonly applied interventions are compulsory service programmes, and financial incentive, or a combination of both. However, these interventions are not rigorously evaluated. Efforts have been made to synthesize existing evidence on the effectiveness of these interventions, but with limited success in portraying a clear picture due to the following constraints: a) lack of literature on attraction and retention in the health sector; b) most existing studies in this area did not use randomized controlled trials, but mostly used Non Randomized Studies, or qualitative approaches; and c) lack of attention paid to the contextual factors and implementation processes of the interventions.

This systematic review will focus on two main types of interventions: a) Compulsory rural services programmes or bonding schemes; b) Direct and indirect financial incentives. For each type of the intervention, the review aims to

1. assess the effectiveness of interventions aiming at promoting attraction and retention of health workers in rural and remote areas in low and middle-income countries.

2. conduct narratives review on how context and implementation process factors influence the intervention effectiveness.

This review will cover two broad types of studies: Non-Randomized Studies and Qualitative studies. It will also include literature on attraction and retention in the education field since education and health fields share many common problems and issues.

Based on non-randomized studies, qualitative studies and studies from the education sector, this systematic review will provide useful evidence on how the contextual factors and implementation process influence the effectiveness of interventions to improve attraction and retention of health workers in remote and rural areas. This will help low- and middle- income countries to design feasible interventions to attract and retain more qualified health workers in rural areas in order to achieve Millennium Development Goals.