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

Abstract

Background Attracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and workforce retention. Methods The review considers studies of rural or remote health workers in HICs where participants have experienced interventions, support measures or incentive programs intended to increase retention. Experimental, quasi-experimental and observational study designs including cohort, case–control, cross-sectional and case series studies published since 2010 were eligible for inclusion. The Joanna Briggs Institute methodology for reviews of risk and aetiology was used. Databases searched included MEDLINE (OVID), CINAHL (EBSCO), Embase, Web of Science and Informit. Results Of 2649 identified articles, 34 were included, with a total of 58,188 participants. All study designs were observational, limiting certainty of findings. Evidence relating to the retention of non-medical health professionals was scant. There is growing evidence that preferential selection of students who grew up in a rural area is associated with increased rural retention. Undertaking substantial lengths of rural training during basic university training or during post-graduate training were each associated with higher rural retention, as was supporting existing rural health professionals to extend their skills or upgrade their qualifications. Regulatory interventions requiring return-of-service (ROS) in a rural area in exchange for visa waivers, access to professional licenses or provider numbers were associated with comparatively low rural retention, especially once the ROS period was complete. Rural retention was higher if ROS was in exchange for loan repayments. Conclusion Educational interventions such as preferential selection of rural students and distributed training in rural areas are associated with increased rural retention of health professionals. Strongly coercive interventions are associated with comparatively lower rural retention than interventions that involve less coercion. Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.

A rapid review of the effectiveness of interventions and innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff

“…The included systematic reviews focused on dentists (Suphanchaimat et al 2016), general practitioners (GPs) (Verma et al 2016), physicians (Kumar and Clancy 2020); the medical workforce including undergraduates (Noya et al 2021), medical undergraduates (Johnson et al 2018), and a variety of different healthcare professionals (Grobler et al 2015, Russell et al 2021, WHO 2020, 2021) including those in training (MacQueen et al 2018).…”

“…Other innovations that were evaluated across the evidence base but did not map to the WHO categories included international recruitment, marketing, retainer schemes, re-entry schemes, specialised recruiters or case managers and delayed partnerships (Verma et al 2016) and those related to health systems (Russell et al 2021).…”

“…• Visa waivers -obligatory service schemes linked to work in rural areas in return for concessions on international medical graduates (IMGs) visa requirements (Kumar and Clancy 2020, Noya et al 2021, Russell et al 2021, Verma et al 2016).…”

“…Evidence from reviews for mixed groups of healthcare professionals Russell et al (2021) found that evidence regarding interventions which required service in rural areas (for a varying length of time) in return for a benefit (exchange for visa waivers, access to professional licenses or provider numbers) were associated with comparatively low rural retention, especially once the RoS period was complete. However, rural retention was higher if RoS was in exchange for loan repayments.…”

“…Three systematic reviews reported on the effectiveness of financial incentives without RoS (Russell et al 2021, Kumar and Clancy 2020, WHO 2020. Financial incentives include:…”