TY - JOUR
T1 - Interventions for health workforce retention in rural and remote areas
T2 - a systematic review
AU - Russell, Deborah
AU - Mathew, Supriya
AU - Fitts, Michelle
AU - Liddle, Zania
AU - Murakami-Gold, Lorna
AU - Campbell, Narelle
AU - Ramjan, Mark
AU - Zhao, Yuejen
AU - Hines, Sonia
AU - Humphreys, John S.
AU - Wakerman, John
N1 - Funding Information:
We recognize that Menzies School of Health Research, Alice Springs, operates on the Arrernte peoples? traditional lands and acknowledge their continued responsibility to care for country. We would like to also acknowledge the invaluable assistance of Flinders University librarian, Josephine McGill, with the construction of the search strategies.
Funding Information:
The research was supported partially by the Australian Government through the Australian Research Council’s Discovery Projects funding scheme (Project DP190100328). The research was additionally supported by the Australian Government’s Medical Research Future Fund with funds distributed through the Central Australia Academic Health Science Network. The views expressed herein are those of the authors and are not necessarily those of the Australian Government, Australian Research Council or the Central Australia Academic Health Science Network.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - Health workforce
KW - Incentives
KW - Personnel
KW - Remote
KW - Retention
KW - Rural
KW - Turnover
KW - Underserved
UR - http://www.scopus.com/inward/record.url?scp=85113459542&partnerID=8YFLogxK
U2 - 10.1186/s12960-021-00643-7
DO - 10.1186/s12960-021-00643-7
M3 - Review Article
C2 - 34446042
AN - SCOPUS:85113459542
SN - 1478-4491
VL - 19
JO - Human Resources for Health
JF - Human Resources for Health
IS - 1
M1 - 103
ER -