Rajbangshi Preety R, Nambiar Devaki, Choudhury Nandini, Rao Krishna D
Public Health Foundation of India, Gurgaon (Haryana), India.
Public Health Foundation of , Gurgaon (Haryana), India.
WHO South East Asia J Public Health. 2017 Sep;6(2):51-59. doi: 10.4103/2224-3151.213792.
Background Like many other low- and middle-income countries, India faces challenges of recruiting and retaining health workers in rural areas. Efforts have been made to address this through contractual appointment of health workers in rural areas. While this has helped to temporarily bridge the gaps in human resources, the overall impact on the experience of rural services across cadres has yet to be understood. This study sought to identify motivations for, and the challenges of, rural recruitment and retention of nurses, doctors and specialists across types of contract in rural and remote areas in India's largely rural north-eastern states of Meghalaya and Nagaland. Methods A qualitative study was undertaken, in which 71 semi-structured interviews were carried out with doctors (n = 32), nurses (n = 28) and specialists (n = 11). In addition, unstructured key informant interviews (n = 11) were undertaken, along with observations at health facilities and review of state policies. Data were analysed using Ritchie and Spencer's framework method and the World Health Organization's 2010 framework of factors affecting decisions to relocate to, stay in or leave rural areas. Results It was found that rural background and community attachment were strongly associated with health workers' decision to join rural service, regardless of cadre or contract. However, this aspiration was challenged by health-systems factors of poor working and living conditions; low salary and incentives; and lack of professional growth and recognition. Contractual health workers faced unique challenges (lack of pay parity, job insecurity), as did those with permanent positions (irrational postings and political interference). Conclusion This study establishes that the crisis in recruiting and retaining health workers in rural areas will persist until and unless health systems address the core basic requirements of health workers in rural areas, which are related to health-sector policies. Concerted attention and long-term political commitment to overcome system-level barriers and governance may yield sustainable gains in rural recruitment and retention across cadres and contract types.
背景
与许多其他中低收入国家一样，印度在农村地区招聘和留住卫生工作者方面面临挑战。印度已通过在农村地区以合同制方式任用卫生工作者来努力解决这一问题。虽然这有助于暂时填补人力资源缺口，但对不同干部类别农村服务体验的总体影响仍有待了解。本研究旨在确定在印度东北部大部分为农村地区的梅加拉亚邦和那加兰邦，各类合同下农村护士、医生和专科医生招聘及留用的动机与挑战。
方法
开展了一项定性研究，对医生（n = 32）、护士（n = 28）和专科医生（n = 11）进行了71次半结构化访谈。此外，还进行了11次非结构化关键信息访谈，并对卫生机构进行了观察以及对国家政策进行了审查。使用里奇和斯宾塞的框架方法以及世界卫生组织2010年影响迁移至、留在或离开农村地区决策的因素框架对数据进行了分析。
结果
研究发现，无论干部类别或合同形式如何，农村背景和社区归属感与卫生工作者加入农村服务的决定密切相关。然而，这种愿望受到了工作和生活条件差、薪资和激励措施低以及缺乏职业发展和认可等卫生系统因素的挑战。合同制卫生工作者面临独特的挑战（薪酬不平等、工作不稳定），有固定职位的人员也面临类似问题（不合理的岗位安排和政治干预）。
结论
本研究表明，农村地区招聘和留住卫生工作者的危机将持续存在，除非卫生系统解决农村地区卫生工作者与卫生部门政策相关的核心基本需求。齐心协力并做出长期政治承诺以克服系统层面的障碍和治理问题，可能会在各类干部和合同形式的农村招聘及留用方面取得可持续的成果。
