Queen Margaret University, Edinburgh, Scotland .
Centre for Rural Health, University of Witwatersrand, Johannesburg, South Africa .
Bull World Health Organ. 2013 Nov 1;91(11):834-40. doi: 10.2471/BLT.13.119008.
The maldistribution of health workers between urban and rural areas is a policy concern in virtually all countries. It prevents equitable access to health services, can contribute to increased health-care costs and underutilization of health professional skills in urban areas, and is a barrier to universal health coverage. To address this long-standing concern, the World Health Organization (WHO) has issued global recommendations to improve the rural recruitment and retention of the health workforce. This paper presents experiences with local and regional adaptation and adoption of WHO recommendations. It highlights challenges and lessons learnt in implementation in two countries - the Lao People's Democratic Republic and South Africa - and provides a broader perspective in two regions - Asia and Europe. At country level, the use of the recommendations facilitated a more structured and focused policy dialogue, which resulted in the development and adoption of more relevant and evidence-based policies. At regional level, the recommendations sparked a more sustained effort for cross-country policy assessment and joint learning. There is a need for impact assessment and evaluation that focus on the links between the rural availability of health workers and universal health coverage. The effects of any health-financing reforms on incentive structures for health workers will also have to be assessed if the central role of more equitably distributed health workers in achieving universal health coverage is to be supported.
卫生工作者在城乡之间的分布不均是几乎所有国家都关注的政策问题。它妨碍了公平获得卫生服务，可能导致城市地区的医疗保健成本增加和卫生专业技能未得到充分利用，并且是实现全民健康覆盖的障碍。为了解决这一长期存在的问题，世界卫生组织（WHO）发布了改善农村地区卫生人力招聘和留用的全球建议。本文介绍了当地和区域适应和采用世卫组织建议的经验。它突出了在两个国家（老挝人民民主共和国和南非）实施过程中的挑战和经验教训，并在两个区域（亚洲和欧洲）提供了更广泛的视角。在国家层面，使用这些建议促进了更有组织和重点的政策对话，从而制定和通过了更相关和基于证据的政策。在区域层面，建议引发了更持续的跨国政策评估和联合学习努力。需要进行影响评估和评价，重点关注农村卫生工作者的供应情况与全民健康覆盖之间的联系。如果要支持更公平分配的卫生工作者在实现全民健康覆盖方面的核心作用，还必须评估任何卫生融资改革对卫生工作者激励结构的影响。
