University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, USA.
Hum Resour Health. 2011 May 21;9:13. doi: 10.1186/1478-4491-9-13.
The ability of many countries to achieve national health goals such as the Millennium Development Goals remains hindered by inadequate and poorly distributed health personnel, including doctors. The distribution of doctors in Ghana is highly skewed, with a majority serving in two major metropolitan areas (Accra and Kumasi), and inadequate numbers in remote and rural districts. Recent policies increasing health worker salaries have reduced migration of doctors out of Ghana, but made little difference to distribution within the country. This qualitative study was undertaken to understand how practicing doctors and medical leaders in Ghana describe the key factors reducing recruitment and retention of health professionals into remote areas, and to document their proposed policy solutions.
In-depth interviews were carried out with 84 doctors and medical leaders, including 17 regional medical directors and deputy directors from across Ghana, and 67 doctors currently practicing in 3 regions (Greater Accra, Brong Ahafo, and Upper West); these 3 regions were chosen to represent progressively more remote distances from the capital of Accra.
All participants felt that rural postings must have special career or monetary incentives given the loss of locum (i.e. moonlighting income), the higher workload, and professional isolation of remote assignments. Career 'death' and prolonged rural appointments were a common fear, and proposed policy solutions focused considerably on career incentives, such as guaranteed promotion or a study opportunity after some fixed term of service in a remote or hardship area. There was considerable stress placed on the need for rural doctors to have periodic contact with mentors through rural rotation of specialists, or remote learning centers, and reliable terms of appointment with fixed end-points. Also raised, but given less emphasis, were concerns about the adequacy of clinical equipment in remote facilities, and remote accommodations.
In-depth discussions with doctors suggest that while salary is important, it is career development priorities that are keeping doctors in urban centers. Short-term service in rural areas would be more appealing if it were linked to special mentoring and/or training, and led to career advancement.
许多国家实现千年发展目标等国家卫生目标的能力仍然受到卫生人员，包括医生数量不足和分布不均的制约。加纳的医生分布严重偏向，大多数医生在两个主要大都市地区（阿克拉和库马西）工作，而偏远和农村地区的医生人数不足。最近提高卫生工作者工资的政策减少了加纳医生的外流，但对国内的分布几乎没有影响。这项定性研究旨在了解加纳的执业医生和医学领导人如何描述减少卫生专业人员到偏远地区招聘和留用的关键因素，并记录他们提出的政策解决方案。
对加纳各地的 84 名医生和医学领导人进行了深入访谈，包括来自加纳各地的 17 名区域医疗主任和副主任，以及目前在 3 个地区（大阿克拉、布隆阿哈福和上西部）执业的 67 名医生；选择这 3 个地区是为了代表离首都阿克拉越来越远的距离。
所有参与者都认为，由于轮班工作（即兼职收入）的损失、更高的工作量和偏远工作地点的职业孤立，农村工作必须有特殊的职业或经济激励。职业“死亡”和长期农村任命是一个常见的担忧，提出的政策解决方案主要集中在职业激励上，例如保证晋升或在远程或艰苦地区服务一定期限后提供学习机会。非常强调农村医生需要通过农村专家轮调和远程学习中心定期与导师保持联系，并需要有固定终点的可靠任命条件。还提出了对远程设施和住宿中临床设备充足性的关注，但强调程度较低。
与医生的深入讨论表明，虽然工资很重要，但职业发展重点是让医生留在城市中心。如果与特殊指导和/或培训挂钩，并导致职业发展，那么在农村地区的短期服务将更具吸引力。
