Location and vocation: why some government doctors stay on in rural Chhattisgarh, India

Abstract

We conducted a qualitative research study in Chhattisgarh State, India, to explore why some qualified medical practitioners decide to stay on in government rural service. The fieldwork consisted of in-depth interviews with 37 practitioners who had an established record of rural service, and data were analyzed using the 'framework' approach for applied policy research. Study participants cited complexes of reasons for staying on, including geographical and ethnic (tribal) affinities, rural upbringing, availability of schools, personal values of service, professional interests, co-location with spouses, and relations with co-workers. Extrinsic (environmental) and intrinsic (personal) factors both play a part in determining the decisions of doctors to stay on, and are interdependent. Some doctors were influenced to remain by the close relationships they had developed with local communities and their acclimatisation over time to rural life. The policy imperative of rural workforce adequacy may be served less by choosing one retention strategy over another than by developing multi-dimensional solutions focused simultaneously on identifying and incentivising rural practitioners with appropriate characteristics, and on creating external conditions for their improved performance and welfare. Further, in a low-income setting such as India, questions of rural workforce adequacy cannot be addressed in isolation, but need to be tackled as part of broad agenda of social development that include strengthening public service systems and empowering communities.

Beyond job security and money: driving factors of motivation for government doctors in India

“…The monetary benefits, such as pension and gratuity, along with nonmonetary benefits such as less workload, are some of the important factors that attract doctors to join and continue in government service. A recent study on government doctors working in rural areas confirms such findings [45]. Similarly, researchers in a study on rural health-care workers of North Vietnam reported that job stability and income were found to be the major motivating factors [13].…”

“…For some, it may be the challenges in work; for others, it may be the opportunities to use their knowledge and skills; others may find sheer professional and scientific interests rewarding; and for yet others, it may be the ability to influence health outcomes. A recent study in the Indian context suggested that MOs were inspired by unique challenges to influence health outcomes in rural areas [45]. The same study also found that feeling of ‘personal fulfilment’, ‘usefulness of practicing in rural areas’ and ‘professional and scientific interest’ were important factors for work motivation [45,46].…”

“…A recent study in the Indian context suggested that MOs were inspired by unique challenges to influence health outcomes in rural areas [45]. The same study also found that feeling of ‘personal fulfilment’, ‘usefulness of practicing in rural areas’ and ‘professional and scientific interest’ were important factors for work motivation [45,46]. …”

“…Evidence shows that inadequate working conditions and facilities, as well as shortages of drugs and equipment, in Fiji, Samoa, Tonga, Cambodia and Pakistan contribute to dissatisfaction of health-care workers with their current jobs [49,53,54]. A study done in India also found that MOs practicing in rural areas are unhappy with the support and facilities available at their health-care centres [45]. Research indicates that inadequate support, supervision and management may lead to reduced work motivation [13,49,55].…”

“…Although the meaning of the term doing something worthwhile is subjective, a research study done in India identified ‘personal values of service to poor’ and ‘selflessness’ as important motivating factors for MOs to work in rural health-care services [45]. Research in the area of organizational behaviour indicates that ‘superordination goals’ contribute to role efficacy among workers.…”