Three Myths about Health Worker Retention

Maurice MiddlebergHow can we encourage health workers to take up and remain in rural postings? This is a key challenge for increasing access to health care. But as we address health worker retention in hard-to-reach areas, there are numerous myths afloat. Here are just a few.

Myth 1. Health workers leave rural posts because they want more money
To be sure, salaries are important. But it’s more complicated than that.

As my colleague Kate Tulenko has pointed out, health workers are consistently among the top wage earners in developing countries. And in terms of international migration, an OECD policy brief notes that while “wage differentials across countries play an important role,” that’s not the only reason health workers leave. Other factors are also at play.

In a South African study cited in Fatu Yumkella’s brief on retention, for example, doctors noted that improving their salary was one of the most important factors for rural retention—yet they also stated that salary alone would not retain them. Money is only one part of the picture.

Myth 2. International migration is the greatest threat
We often think that developing-country health workers’ migration to the US, UK, and elsewhere is the most pressing challenge we face in addressing the workforce shortage. But it’s less of a concern for rural health care than we might expect.

The greatest shortages of health workers tend to be in rural areas. But health workers are migrating from cities to developed countries, rather than from rural posts. According to the OECD brief, “most international migrants come from urban areas” in their home countries.

Myth 3. We know why health workers leave their jobs, and why they stay
In my previous post on retention, I noted two core lessons I’ve learned: We need to ask health workers themselves which incentives matter most; and health worker motivations are complex.

In his brief on motivation, my colleague Jim McCaffery cites a review of incentive programs from 16 African countries aimed at rural retention. A main conclusion was that there is no one-size-fits-all solution, or clear answer for which incentives health workers will respond to.

We need a tailored bundle of incentives to help attract health workers to rural service and encourage them to stay. The elements of that bundle need to correspond to what matters most to workers in a particular area.

CapacityPlus is partnering with the WHO to help apply its global retention recommendations in country-specific settings. And in Uganda, we field-tested a user-friendly assessment tool to address attraction and retention in remote areas. The results from this rapid assessment, along with CapacityPlus’s retention costing tool, will assist the Ministry of Health in designing retention packages.

We can help countries move closer to staffing their remote clinics with professionals who want to be there—and help increase access to care.