Evaluation of recruitment and retention strategies for health workers in rural Zambia

Abstract

BackgroundIn response to Zambia’s critical human resources for health challenges, a number of strategies have been implemented to recruit and retain health workers in rural and remote areas. Prior to this study, the effectiveness of these strategies had not been investigated. The purpose of this study was to determine the impacts of the various health worker retention strategies on health workers in two rural districts of Zambia.MethodsUsing a modified outcome mapping approach, cross-sectional qualitative and quantitative data were collected from health workers and other stakeholders through focus group discussions and individual interview questionnaires and were supplemented by administrative data. Key themes emerging from qualitative data were identified from transcripts using thematic analysis. Quantitative data were analyzed descriptively as well as by regression modelling. In the latter, the degree to which variation in health workers’ self-reported job satisfaction, likelihood of leaving, and frequency of considering leaving, were modelled as functions of participation in each of several retention strategies while controlling for age, gender, profession, and district.ResultsNineteen health worker recruitment and retention strategies were identified and 45 health care workers interviewed in the two districts; participation in each strategy varied from 0% to 80% of study participants. Although a salary top-up for health workers in rural areas was identified as the most effective incentive, almost none of the recruitment and retention strategies were significant predictors of health workers’ job satisfaction, likelihood of leaving, or frequency of considering leaving, which were in large part explained by individual characteristics such as age, gender, and profession. These quantitative findings were consistent with the qualitative data, which indicated that existing strategies fail to address major problems identified by health workers in these districts, such as poor living and working conditions.ConclusionsAlthough somewhat limited by a small sample size and the cross-sectional nature of the primary data available, the results nonetheless show that the many health worker recruitment and retention strategies implemented in rural Zambia appear to have little or no impact on keeping health workers in rural areas, and highlight key issues for future recruitment and retention efforts.

Use of information and communication technology and retention of health workers in rural post-war conflict Northern Uganda: findings from a qualitative study

“…Though there have been substantial studies on other factors that influence retention of health workers in rural areas such as pay rise, good housing and others [6], little attention has been put to explore the influence of ICT use on retention of health workers in rural and remote areas [3, 5]. Just as the case in favour of ICT use in promoting the retention of health care providers in rural areas has been made, it is also reasonable to explore the perceptions of health workers on whether ICT facilities and infrastructural development might contribute to retention in rural post-war conflict northern Uganda.…”

“…Though these efforts are continuously being implemented, attracting and retaining skilled health workers in rural areas in Uganda still remains elusive. Data on retention of health professionals in Uganda is reported as inadequate; however some of the top strategies that are thought to support retention are: providing accommodation, providing salary top-up for health care providers willing to work in hard-to-reach areas, improving the style of supervision and management, education and training opportunities for health workers, improving work conditions, providing social needs support, and health and access to antiretroviral treatment (ART) [2, 3, 6, 15–18]. Despite all these strategies having been tried, significant shortage of health professionals still remains a big challenge [19, 20], especially having trained health professionals retained in remote rural areas [21, 22].…”

“…Many times, effectiveness of retention strategies for health professionals is not evaluated and their implementation is done without considering the needs, preferences and perceptions of health professionals themselves [26]. Much as other retention strategies for health professionals have been reported, they do not meet all the requirements for complete attraction and retention [6] and many have yielded little success [27]. The aim of this study was to explore other retention strategies with the potential to enhance retention of health professionals in rural and remote areas.…”

Graduação em saúde: oferta e estratégias para o fortalecimento da regionalização do Sistema Único de Saúde

“…Com base nas análises, é importante pontuar que, embora se verifique a permanência de egressos no entorno das universidades, os que se formam em regiões metropolitanas ou muito próximas a elas tendem a se fixar ou a buscar fixação nas capitais ou em municípios de maior desenvolvimento econômico, o que ratifica que a maior dificuldade não é a de reter o profissional no estado ou na região de saúde, mas no interior e em áreas mais remotas 18,19,20,21 .…”

“…Mais ainda, a universidade avaliza a participação da região no uso dos recursos nacionais, contribuindo para o fortalecimento da capacidade de organização social da região. O desenvolvimento de pesquisas, por exemplo, contribui significativamente para o surgimento de indústrias, novos produtos e tecnologias, com efeitos na economia local 18 , conforme pontuado por parte dos gestores de ensino.…”