From Rural Virginia to Remote Areas of Laos: Keeping Health Workers in the Communities That Need Them

Maurice MiddlebergOn a recent Monday I spotted an article in the Washington Post about a young doctor who accepted a position in rural Virginia. She and many other health workers are struggling to balance their professional commitment—“I really wanted to help people who wouldn’t otherwise get help,” Dr. Sarah Carricaburu told the reporter—with the drawbacks of living far from an urban center. She’s not sure if she’ll stay.

I was struck by the similar context of this article and the stories I hear every week from developing countries around the world. The factors driving doctors and nurses away from rural posts in the US are largely the same as those in developing countries—social and professional isolation, access to the Internet, housing, cultural options, schooling for children, lack of opportunity for continuing education.

We often assume the problem is one of salary. But it’s more complicated than that.

Incentives that matter to health workers
Recently the World Health Organization issued global policy recommendations for helping increase access to health workers through improved retention. What’s clear is that we need to ask the health workers themselves which incentives matter most. We can’t assume we know why they leave. Motivations are complex, and salary is only one factor.

To help attract health workers to remote communities and encourage them to stay, we need a tailored bundle of incentives. The specific elements of that bundle must be tailored to the incentives that matter most to health workers, while meeting tests of feasibility and affordability.

Helping countries with retention
CapacityPlus is doing a lot of work in this area. We’re partnering with the WHO to help apply the retention recommendations in country-specific settings.

In Laos, we’re working with the Ministry of Health on a plan to implement retention strategies. We hope to build the Ministry’s capacity to apply tools for assessing health worker preferences and costing retention interventions. CapacityPlus is currently developing these tools.

In Uganda, CapacityPlus will help conduct a step-by-step process to obtain health worker preferences in order to prioritize and bundle the menu of options in the Ministry of Health’s retention and motivation strategy. This will help Uganda’s government in designing effective incentive packages.

Assessing the impact
Going forward, we need to see the marginal impact of different incentives and amass some evidence that each incentive increases retention. If a government implements an incentives package, did it actually retain health workers?

We need a holistic, context-sensitive approach to keep dedicated health workers on the job in the communities that need them. The WHO recommendations provide a good guide to action. This is a problem we can solve.

Thanks to Sarah Dwyer for assistance with this post.

Photo: IntraHealth International