A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh

Abstract

BackgroundBangladesh is a highly populous country with three-quarters rural population. Pressing national shortages in health professionals has resulted in high vacancy rates in rural areas. These are compounded by excessive absenteeism and low retention among nurses and doctors posted to rural locations. This study attempts to ascertain reasons for providers’ reluctance to work in rural and remote areas and to identify ways in which these barriers to appropriate staffing might be resolved.MethodsThis is a qualitative study based on in-depth interviews with healthcare providers (n = 15) and facility managers (n = 4) posted in rural areas, and key informant interviews with health policymakers at the national level (n = 2). Interview guides were written in English and translated and administered in Bengali. The collected data were re-translated and analyzed in English. Braun and Clarke’s thematic analysis approach (data familiarization, coding, identifying and reviewing themes, and producing a final report) was used.ResultsParticipants reported poor living conditions in rural areas (e.g., poor housing facilities and unsafe drinking water); overwhelming workloads with poor safety and insufficient equipment; and a lack of opportunities for career development, and skill enhancement. They reported insufficient wages and inadequate opportunities for private practice in rural areas. Managers described their lack of sufficient authority to undertake disciplinary measures for absenteeism. They also pointed at the lack of fairness in promotion practices of the providers. Policymakers acknowledged unavailability or insufficient allowances for rural postings. There is also a lack of national policy on rural retention.ConclusionsThe findings revealed a complex interplay of factors influencing doctors’ and nurses’ availability in rural and remote public health facilities from the perspective of different players in the healthcare delivery system of Bangladesh. In addition, the study generated several possibilities for improvement, including increased allowances and incentives for rural posting; a transparent and fair promotion system for serving in rural areas; enhanced authority of the local managers for reducing worker absenteeism; and improved national policies on rural retention.

Challenges of Satisfaction of Key Stakeholders of the District Health System of Bangladesh and Ways to Improve: A Qualitative Study

“…These findings are consistent with the study and such incentives have proved effective elsewhere in the world [13]. Additionally, the existing two-year rural working rule should be strictly implemented.…”

Balancing satisfaction, balancing health

“…These findings are consistent with the study of Darkwa et al (2015) and such incentives have proved effective elsewhere in the world. Additionally, the existing two-year rural working rule should be strictly implemented.…”

Majmawalas and sexual health promotion in Bangladesh: An ethnography of street healers in Dhaka City

“…The Bangladesh Health Watch Report (BHWR, 2008) notes that qualified modern practitioners account for a small proportion of the entire workforce, making up just 5% of all health care providers with just 7.7 physicians, dentists and nurses together per 10,000 population (BHWR, 2008: ii). The recent reviews of the Bangladesh health system (Islam and Biswas, 2014;Khan et al 2015;Darkwa et al 2015;Khatun et al 2015) echo the similar critical shortage of professional health workforces. All of these recent studies confirm that there is no significant change in the number of the professional health workforce in recent time in Bangladesh.…”

“…In the secondary and tertiary levels, the Government of Bangladesh has established only 124 hospitals with 41,655 beds . Policy researchers (Adams et al, 2015;Adams et al, 2013;Ahmed et al, 2013;Chowdhury et al, 2013;Darkwa et al 2015) find the government health care sector to be extremely centralised. The shortage of resources and centralisation are responsible for the poor capacity of the sector (Adams et al, 2013).…”

“…They further note that almost two-thirds of the total facilities operate with less than 75% of the sanctioned staff working in the facilities. Facilities in rural areas suffer more than urban areas as professionals are less inclined to stay in rural areas (Darkwa et al 2015;Ahmed, 2005;Cockcroft et al, 2007;Cockcroft et al, 2004;Mahmood et al, 2010). Conversely, 70% of the Bangladeshi population live in rural areas (BBS, 2012).…”