Odhiambo Jackline, Rwabukwisi Felix Cyamatare, Rusangwa Christian, Rusanganwa Vincent, Hirschhorn Lisa Ruth, Nahimana Evrard, Ngamije Patient, Hedt-Gauthier Bethany Lynn
Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.
Ministry of Health, Kigali, Rwanda.
Pan Afr Med J. 2017 Jul 4;27:168. doi: 10.11604/pamj.2017.27.168.11943. eCollection 2017.
The shortage and maldistribution of health care workers in sub-Saharan Africa is a major concern for rural health facilities. Rural areas have 63% of sub-Saharan Africa population but only 37% of its doctors. Although attrition of health care workers is implicated in the human resources for health crisis in the rural settings, few studies report attrition rates and risk factors for attrition in rural district hospitals in sub-Saharan Africa.
We assessed attrition of health care workers at a Kirehe District Hospital in rural Rwanda. We included all hospital staff employed as of January 1, 2013 in this retrospective cohort study. We report the proportion of staff that left employment during 2013, and used a logistic regression to assess individual characteristics associated with attrition.
Of the 142 staff employed at Kirehe District Hospital at the start of 2013, 31.7% (n=45) of all staff and 81.8% (n=9) of doctors left employment in 2013. Being a doctor (OR=10.0, 95% CI: 1.9-52.1, p=0.006) and having up to two years of experience at the hospital (OR=5.3, 95% CI: 1.3-21.7, p=0.022) were associated with attrition.
Kirehe District Hospital experienced high attrition rates in 2013, particularly among doctors. Opportunities for further training through Rwanda's Human Resources for Health program in 2013 and a two-year compulsory service program for doctors that is not linked to interventions for rural retention may have driven these patterns. Efforts to link these programs with rural placement and retention strategies are recommended.
撒哈拉以南非洲地区医护人员短缺及分布不均是农村卫生设施面临的一个主要问题。农村地区居住着撒哈拉以南非洲63%的人口，但仅有37%的医生。尽管医护人员流失与农村地区的卫生人力资源危机有关，但很少有研究报告撒哈拉以南非洲农村地区医院的人员流失率及流失风险因素。
我们评估了卢旺达农村基雷赫地区医院医护人员的流失情况。在这项回顾性队列研究中，我们纳入了截至2013年1月1日受雇的所有医院工作人员。我们报告了2013年离职的工作人员比例，并使用逻辑回归分析来评估与人员流失相关的个体特征。
2013年初基雷赫地区医院雇用的142名工作人员中，2013年所有工作人员中有31.7%（n = 45）离职，医生中有81.8%（n = 9）离职。身为医生（比值比=10.0，95%置信区间：1.9 - 52.1，p = 0.006）以及在该医院工作至多两年（比值比=5.3，95%置信区间：1.3 - 21.7，p = 0.022）与人员流失有关。
基雷赫地区医院在2013年经历了高流失率，尤其是医生。2013年通过卢旺达卫生人力资源项目提供的进一步培训机会以及一项与农村留用干预措施无关的医生两年强制服务项目可能导致了这些情况。建议努力将这些项目与农村安置和留用策略联系起来。
