Retention of doctors in rural health services in Thailand: impact of a national collaborative approach

Arora, Rajin; Chamnan, Parinya; Nitiapinyasakul, Achara; Lertsukprasert, Suwat

doi:10.22605/rrh4344

Cited by 18 publications

(43 citation statements)

References 14 publications

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“…For student selection, most studies demonstrated rural background was associated with both rural preference [33][34][35][36][37][38][39][40][41][42][43][44][45][46]54] and actual work [26], while several found no association with rural preference [47][48][49]56]. Being enrolled through the 'special track' , which consists of rural student recruitment, scholarships and receive a rural-oriented curriculum, were associated with actual work in rural areas [27][28][29][30][31][32]. Other student selection factors associated with rural preference were: having parents with lower educational level or wealth [38,40,43,46] or with an income source from the agricultural sector [37,44], entering medical school through a graduate track [47], and having graduated from a government-owned high school [43]; however, there was no evidence for such association with the actual work.…”

Section: Educationalmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Educationalmentioning

confidence: 99%

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

et al. 2020

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“…For example, in Thailand, the Collaboration for Production of Increased Rural Doctors (CPIRD) programme supports medical students of rural origin in studying pre-clinical medicine in universities alongside their urban-origin peers before providing clinical placements within Ministry of Public Health hospitals. 5 However, despite these and similar initiatives, global shortages in rural family medicine persist. Importantly, the majority of these rural medical education initiatives have been based in larger regional hospitals that place an emphasis on non-family medicine specialist rotations that is similar to the curricular approach in city hospitals.…”

Section: Cal Workforce Development Through the Rural Health Multidiscmentioning

confidence: 99%

“…Although post-psychometric is different to antipsychometric, it is rarely articulated as such. [5][6][7][8] In fact, it is barely articulated at all, aside from being 'beyond' psychometrics. 9…”

Section: Situating Medical Student Training In Rural Family Practice mentioning

confidence: 99%

Call to expand teaching opportunities in rural family medicine

Walters

Worley

2020

Medical Education

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| 97 COMMENTARIES 15. Stone L, Phillips C, Douglas KA. Sexual assault and harassment of doctors, by doctors: a qualitative study. Med Educ. 2019;53:833-843. 16. Stone LE, Douglas K, Mitchell I, Raphael B. Sexual abuse of doctors by doctors: professionalism, complexity and the potential for healing. Med J Aust. 2015;203:170-171. 17. Becker JC, Zawadzki MJ, Shields SA. Confronting and reducing sexism: a call for research on intervention. J Soc Issues. 2014;70:603-614. 18. Kuchynka SL, Salomon K, Bosson JK, et al. Hostile and benevolent sexism and college women's STEM outcomes. Psychol Women Q. 2018;42:72-87. 19. Dumont M, Sarlet M, Dardenne B. Be too kind to a woman, she'll feel incompetent: benevolent sexism shifts self-construal and autobiographical memories toward incompetence. Sex Roles. 2010;62:545-553. 20. Clow KA, Ricciardelli R, Bartfay WJ. Are you man enough to be a nurse? The impact of ambivalent sexism and role congruity on perceptions of men and women in nursing advertisements. Sex Roles. 2015;72:363-376. 21. Jost JT, Kay AC. Exposure to benevolent sexism and complementary gender stereotypes: consequences for specific and diffuse forms of system justification. J Pers Soc Psychol. 2005;88:498-509. 22. Peeters G. From good and bad to can and must: subjective necessity of acts associated with positively and negatively valued stimuli. Eur J Soc Psychol. 2002;32:125-136. 23. Hughes F, Bernstein PS. Sexism in obstetrics and gynecology: not just a 'women's issue'. Am J Obstet Gynecol. 2018;219:364.e1-364.e4. 24. Becker JC, Swim JK. Seeing the unseen: attention to daily encounters with sexism as way to reduce sexist beliefs. Psychol Women Q.

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“…Shortage of doctors and other HCPs in rural areas-in other words, unbalanced distribution of health personnel between and within countries -continues to be a growing concern globally. [4][5][6][7][8][9][10][11][12][13]22 Lack of facilities has emerged as the main barrier to recruitment and retention in the present study, Similar to our findings, in a qualitative study of factors influencing retention of rural healthcare staff in Bangladesh has reported (according to doctors and paramedical staff) poor living conditions (e.g. poor housing facilities and unsafe drinking water); overwhelming workloads with poor safety and insufficient equipment; a lack of opportunities for career development and skill enhancement; insufficient wages and inadequate opportunities for private practice.…”

Section: Themementioning

confidence: 99%

“…This problem exists all over the world in both resourcepoor and resource-rich setups in varying proportions and forms. [4][5][6][7][8][9][10][11][12][13] Doctor-population ratio has improved significantly in India during the last seven decades of independence; yet on account of "urban concentration" of doctors and "urban dependence", there exist several problems for the rural poor. Government employed doctors manage to perpetually stay in the urban areas, undisturbed for a lifetime.…”

Section: Introductionmentioning

confidence: 99%

Simple and basic yet vital and essential health services: an exploration of perception of junior health care service providers regarding rural health services in India

Joshi¹,

Joshi²

2018

Int J Community Med Public Health

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Background: Health services should be scientifically reviewed and researched continuously.. In 2017, at the occasion of completion of seven decades of the India's Independence, a self-funded “doctors' perception study project” was launched. Present paper is an outcome of this project which will soon be followed by similar projects involving other stakeholders of health care as well.Methods: Fifteen individual face to face in depth interviews (FFIDIs) and ten focus group discussions (FGDs) were conducted during the year 2017 among the junior level health care providers working at a rural health training center. Thematic (content) analysis method was used.Results: A big gap exists between the concept and its implementation. Several ‘people factors’ and ‘system factors’ emerged besides quite a few ‘contradictions’, ‘malpractices’ and ‘deficiencies’. Perceptions regarding various ‘priority domains’ for improvement, ‘needs’ and ‘strategies’ were also explored. The emphasis was on improving peoples’ awareness action and access; staff recruitment, health care facilities and patient referral.Conclusions: Access barriers are disastrous and devastating for the poor and the disabled. There is a close mutual relation among the various issues. Chaos is being allowed to exist in which there are irrational use of drugs, mushrooming of ‘quacks’ and diversion of resources from public to private sector. Addressing all the issues requires peoples’ awareness and action along with political and administrative vision and will. A different politics is needed. Introspection, internal reforms and more community engagement is expected from the medical community.

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Retention of doctors in rural health services in Thailand: impact of a national collaborative approach

Cited by 18 publications

References 14 publications

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

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

Call to expand teaching opportunities in rural family medicine

Simple and basic yet vital and essential health services: an exploration of perception of junior health care service providers regarding rural health services in India

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