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Dr Carmen Dolea Department of Human Resources for Health, WHO, Geneva

Getting and keeping health workers in remote and rural areas: the WHO global policy recommendations. Dr Carmen Dolea Department of Human Resources for Health, WHO, Geneva Presented by: Prof James Buchan, QMU jbuchan@qmu.ac.uk http://www.who.int/hrh/retention/guidelines/en/index.html.

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Dr Carmen Dolea Department of Human Resources for Health, WHO, Geneva

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  1. Getting and keeping health workers in remote and rural areas: the WHO global policy recommendations Dr Carmen Dolea Department of Human Resources for Health, WHO, Geneva Presented by: Prof James Buchan, QMU jbuchan@qmu.ac.uk http://www.who.int/hrh/retention/guidelines/en/index.html

  2. Overview – developing the WHO recommendations Why “guidelines”? How did we go about it? What are the WHO recommendations?

  3. Why “guidelines” for rural retention "Recommendation/guideline" implies a course of action needs to be taken AND that progress can be measured against a set baseline "Policy options" are good, but may remain "optional", not "actioned upon" • Systematic, explicit and transparent process of evidence gathering/assessment and of formulating the recommendations

  4. How did we go about it

  5. Access to health workers in remote and rural areas depends on two inter-related aspects

  6. Factors influencing decisions to stay in or leave rural and remote areas Personal Rural background (origin), values, altruism Family and community Provision of schooling for children, sense of community spirit, community facilities available Financial aspects Benefits, allowances, salaries, payment system Career related Access to continuing education opportunities, supervision, professional development courses/ workshops etc, senior posts in rural areas Working and living conditions Infrastructure, working environment, access to technology/medicines, housing conditions etc Bonding or mandatory service: Whether obligated to serve there Source: WHO 2010 6

  7. The 16 WHO global policy recommendations

  8. Education interventions: the “rural pipeline” • Support of rural HCWs: nurturing the RIGHT ENVIRONMENT • Career ladders for rural health workers (South Africa) • Postgraduate training: creating the RIGHT OPPORTUNITIES • Rural residency programmes (Sudan, Australia, Canada) • Undergraduate training: getting the RIGHT CONTEXT • create schools outside major cities (Mali, Canada) • rural clinical placements in rural areas (Australia) • changes in curricula (South Africa) • Student selection: choosing the RIGHT PEOPLE • targeting admission of students from a rural background (Sudan; Thailand)

  9. Regulatory interventions: different types of health workers or different types of contracts Compulsory service: not always effective, requires reinforcement and heavy administration Enhancing the scope of practice for rural health workers: more duties and responsibilities, not always accompanied with adequate rewards Different types of health workers: clinical officers a potential solution

  10. Financial incentives: how much is "large enough"?

  11. Professional and personal support: most likely to work, yet very little done for it • Living and working conditions • Professional networks, journals etc • Outreach support/telemedicine • Career ladders for rural health workers • Titles, awards, public recognition

  12. Retention strategies – from planning to implementation, monitoring and evaluation

  13. Roadmap and tools for implementation Source: Draft WHO/CapacityPlus/WB roadmap to support implementation of rural retention strategies

  14. Choosing the most appropriate interventions Decisions often driven by everything else but evidence However, some essential criteria need to be considered before selecting a package: Effectiveness Relevance: Time to impact Enforcement capacity Urban underemployment Acceptability Affordability Complementarities

  15. Time to impact Source: Draft WHO/CapacityPlus/WB roadmap to support implementation of rural retention strategies

  16. Monitoring and evaluation: a framework for measuring results • Number of students from rural background reporting their intention to practice in rural/remote/underserved area • Number of students from rural background selected/recruited into medical or health professional schools • Number of students from rural background retained in rural/remote/underserved area Source, WHO, 2010

  17. A complex issue in a complex environment Development partners WHO World Bank Ministry of Finance GAVI Ministry of Health The Global Fund Ministry of Labour PEPFAR Health workers Ministry of Higher Education Professional Associations Civil Service Commission Populations/Communities Ministry of Public Administration Ministry of Transport

  18. Thank you for your attention!For further information, please contact Dr Carmen Dolea: doleac@who.inthttp://www.who.int/hrh/retention/guidelines/en/index.html

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