Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review

Abstract

Background More than 60% of the world’s rural population live in the Asia-Pacific region. Of these, more than 90% reside in low- and middle-income countries (LMICs). Asia-Pacific LMICs rural populations are more impoverished and have poorer access to medical care, placing them at greater risk of poor health outcomes. Understanding factors associated with doctors working in rural areas is imperative in identifying effective strategies to improve rural medical workforce supply in Asia-Pacific LMICs. Method We performed a scoping review of peer-reviewed and grey literature from Asia-Pacific LMICs (1999 to 2019), searching major online databases and web-based resources. The literature was synthesized based on the World Health Organization Global Policy Recommendation categories for increasing access to rural health workers. Result Seventy-one articles from 12 LMICs were included. Most were about educational factors (82%), followed by personal and professional support (57%), financial incentives (45%), regulatory (20%), and health systems (13%). Rural background showed strong association with both rural preference and actual work in most studies. There was a paucity in literature on the effect of rural pathway in medical education such as rural-oriented curricula, rural clerkships and internship; however, when combined with other educational and regulatory interventions, they were effective. An additional area, atop of the WHO categories was identified, relating to health system factors, such as governance, health service organization and financing. Studies generally were of low quality—frequently overlooking potential confounding variables, such as respondents’ demographic characteristics and career stage—and 39% did not clearly define ‘rural’. Conclusion This review is consistent with, and extends, most of the existing evidence on effective strategies to recruit and retain rural doctors while specifically informing the range of evidence within the Asia-Pacific LMIC context. Evidence, though confined to 12 countries, is drawn from 20 years’ research about a wide range of factors that can be targeted to strengthen strategies to increase rural medical workforce supply in Asia-Pacific LMICs. Multi-faceted approaches were evident, including selecting more students into medical school with a rural background, increasing public-funded universities, in combination with rural-focused education and rural scholarships, workplace and rural living support and ensuring an appropriately financed rural health system. The review identifies the need for more studies in a broader range of Asia-Pacific countries, which expand on all strategy areas, define rural clearly, use multivariate analyses, and test how various strategies relate to doctor’s career stages.

Interventions for health workforce retention in rural and remote areas: a systematic review

“…The structure of the narrative synthesis of extracted data was based on categories for rural health workforce interventions used in the WHO Global Policy Recommendations [ 26 ]: education; regulatory interventions; financial incentives; and personal and professional support. A further category—health systems—was added, as proposed by Putri et al [ 27 ].…”

Factors Affecting Retention in the Philippine National Rural Physician Deployment Program From 2012 to 2019: A Mixed Methods Study

“…On the other hand, geographic isolation, burn-out, poor access to electricity, telecommunications and potable water, lack of support from their host LGUs and from the national government, and safety and security issues hinder DTTBs from staying in their communities after serving their two-year contract. Some of these ndings have been corroborated by one scoping review of factors to increase the supply of rural health physicians (24), but some factors are context-speci c and were not touched upon in the review yet.…”

Factors affecting retention in the Philippine National Rural Physician Deployment Program from 2012 to 2019: a mixed methods study

“…On the other hand, geographic isolation, burn-out, poor access to electricity, telecommunications, and potable water, lack of support from their host LGUs and from the national government, and safety and security issues hinder DTTBs from staying in their communities after serving their two-year contract. Some of these findings have been corroborated by one scoping review of factors to increase the supply of rural health physicians, but some factors are contextspecific and were not touched upon in the review yet [26]. Improving retention of rural health physicians require the implementation of interventions on education, regulation, financial incentives, and professional and personal support [27,28].…”

“…As a result, the DTTBs feel that they do not get the support they need to implement public health programs in the community. Lack of supportive leadership and poor relationships with colleagues have been found to contribute to poor retention [23,26,[31][32][33]. Because of this, the roles and responsibilities of the DTTB to both DOH and the LGU should be clarified, and the DOH, being the national agency, should play a more active role in ensuring that DTTBs can implement their programs for their communities.…”