Nagai Mari, Fujita Noriko, Diouf Ibrahima S, Salla Malick
Division of Global Health Programs, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
Department of Human Resources, Ministry of Health and Social Actions, Dakar, Senegal.
Rural Remote Health. 2017 Jul-Sep;17(3):4149. doi: 10.22605/RRH4149. Epub 2017 Sep 12.
Deployment and retention of a sufficient number of skilled and motivated human resources for health (HRH) at the right place and at the right time are critical to ensure people's right to access a universal quality of health care. Vision Tokyo 2010 Network, an international network of HRH managers at the ministry of health (MoH) level in nine Francophone African countries, identified maldistribution of a limited number of healthcare personnel and their retention in rural areas as overarching problems in the member countries. The network conducted this study in Senegal to identify the determining factors for the retention of qualified HRH in rural areas, and to explore an effective and feasible policy that the MoH could implement in the member countries.
Doctors, nurses, midwives and superior technicians in anesthesiology who were currently working (1) in a rural area and had been for more than 2 years, (2) in Dakar with experience of working in a rural area or (3) in Dakar without any prior experience working in a rural area were interviewed about their willingness and reasons for accepting work or continuing to work in a rural area and their suggested policies for deployment and retention of healthcare workers in rural areas. In-depth interviews were conducted with policy makers in MoH, asking for their perceptions on human resource management in health and about their suggested policies for deployment and retention.
A total of 176 healthcare workers and eight policy makers were interviewed. The willingness to face challenges in a new place was one of the main reasons for accepting work in rural areas. The identified factors to motivate or demotivate healthcare workers in rural areas were related to pre-service and in-service education, regulatory systems, financial and non-financial incentive schemes and environmental support. Factors not included in WHO's global recommendation but highly valued in this study were (1) the fairness, transparency and predictability of human resource management by the MoH and (2) employment status, ie permanent government staff versus contract staff. Financial incentive schemes were less commonly suggested. Family bonding and religious-related non-financial incentive schemes were found to be specific factors in Senegal, but would also be applicable in countries where family and religion play important roles in the values of healthcare workers.
Improved HRH management, eg the transparency of human resource management by the MoH, was identified as a pre-condition of any policy implementation related to HRH. This factor can be considered in other countries struggling to retain healthcare workers in rural areas. The Vision Tokyo 2010 Network or HRH managers' network in Francophone Africa, Senegal MoH and the research team plan to conduct a quantitative survey to confirm the generalizability of the results of this qualitative survey, and to identify the most effective combination of policies to improve the retention of qualified healthcare workers and seek their implementation in other countries in the region as network activities.
在合适的地点和时间部署并留住足够数量技术熟练且积极性高的卫生人力资源对于确保人们获得普遍优质医疗保健的权利至关重要。“东京2010愿景网络”是一个由九个法语非洲国家卫生部层面的卫生人力资源管理人员组成的国际网络，该网络指出成员国存在医疗人员数量有限且分布不均以及他们留在农村地区等首要问题。该网络在塞内加尔开展了这项研究，以确定农村地区留住合格卫生人力资源的决定性因素，并探索卫生部可在成员国实施的有效可行政策。
对目前正在（1）农村地区工作且工作超过两年、（2）在达喀尔且有农村地区工作经验或（3）在达喀尔但此前无农村地区工作经验的医生、护士、助产士和麻醉学高级技师进行访谈，询问他们接受或继续在农村地区工作的意愿及原因，以及他们对农村地区卫生工作者部署和留住的建议政策。对卫生部政策制定者进行深入访谈，询问他们对卫生人力资源管理的看法以及他们对部署和留住人员的建议政策。
共访谈了176名卫生工作者和8名政策制定者。愿意在新地方迎接挑战是接受农村地区工作的主要原因之一。确定的激励或阻碍农村地区卫生工作者的因素与职前和在职教育、监管系统、财务和非财务激励计划以及环境支持有关。世界卫生组织全球建议中未包括但在本研究中高度重视的因素是（1）卫生部人力资源管理的公平性、透明度和可预测性以及（2）就业状况，即政府长期工作人员与合同制工作人员。较少有人提及财务激励计划。家庭关系和宗教相关的非财务激励计划被发现是塞内加尔的特定因素，但在家庭和宗教在卫生工作者价值观中发挥重要作用的国家也适用。
改善卫生人力资源管理，如卫生部人力资源管理的透明度，被确定为与卫生人力资源相关的任何政策实施的前提条件。在其他努力留住农村地区卫生工作者的国家也可考虑这一因素。“东京2010愿景网络”或法语非洲的卫生人力资源管理人员网络、塞内加尔卫生部和研究团队计划进行定量调查，以确认本次定性调查结果的普遍性，并确定提高合格卫生工作者留存率的最有效政策组合，并作为网络活动在该地区其他国家寻求实施这些政策。
