Global Health Research Center, Duke Kunshan University, Kunshan, China.
Duke Global Health Institute, Duke University, Durham, United States of America.
Hum Resour Health. 2019 Jan 7;17(1):2. doi: 10.1186/s12960-018-0340-6.
Many Asia-Pacific countries are experiencing rapid changes in socio-economic and health system development. This study aims to describe the strategies supporting rural health worker attraction and retention in Cambodia, China, and Vietnam and explore the context influencing their outcomes.
This paper is a policy analysis based on key informant interviews with stakeholders about a rural province of Cambodia, China, and Vietnam, coupled with a broad review of the literature.
Cambodia, China, and Vietnam have implemented medical education, provided financial incentives, and provided personal and professional support to attract and retain rural health workers. More socio-economic development was related to a wider range of interventions and their scope. The health system context influenced the outcomes. Increased autonomy of public hospitals attracted more health workers from rural primary health facilities in China and Vietnam. Health financing policies for universal health coverage in China and Vietnam have increased the utilization of health services. Subsidies for poor people to access health services in Cambodia have provided financial incentives to retain rural health workers. However, the dismantling of the referral system in China and Vietnam has resulted in a high rate of health workers moving from primary health facilities to higher-level hospitals while clear definition of primary healthcare package in Cambodia guided its planning of primary health workforce. The prosperous private health sector in Cambodia and Vietnam attracted more health workers from rural primary health facilities, impeded implementation and determined effectiveness of financial incentives.
Socio-economic and health system reforms including health financing, public hospital autonomy, abolition of referral system and prosperous private sector have both positive and negative impacts on the design, implementation, and effectiveness of interventions to attract and retain rural health workers. Interventions to attract and retain health workers in rural and remote areas need to be considered within overall health system reform.
许多亚太国家正在经历社会经济和卫生系统发展的快速变化。本研究旨在描述支持柬埔寨、中国和越南农村卫生工作者吸引力和留用的战略，并探讨影响其结果的背景因素。
本文是一项基于对柬埔寨、中国和越南农村省份的利益攸关方进行关键知情人访谈的政策分析，同时对文献进行了广泛回顾。
柬埔寨、中国和越南实施了医学教育、提供财政激励以及提供个人和专业支持，以吸引和留住农村卫生工作者。更多的社会经济发展与更广泛的干预措施及其范围有关。卫生系统背景影响了结果。公立医院自主权的增加吸引了更多的卫生工作者从中国和越南的农村初级卫生保健机构流动。中国和越南的全民健康覆盖卫生融资政策增加了卫生服务的利用。柬埔寨为贫困人口获得卫生服务提供补贴，为留住农村卫生工作者提供了财政激励。然而，中国和越南转诊系统的废除导致了从初级卫生保健机构向更高层次医院流动的卫生工作者比例较高，而柬埔寨明确界定初级医疗保健包则指导了其初级卫生人力规划。柬埔寨和越南繁荣的私营卫生部门吸引了更多的农村初级卫生保健机构的卫生工作者，阻碍了财政激励措施的实施和有效性的确定。
包括卫生融资、公立医院自主权、废除转诊系统和繁荣的私营部门在内的社会经济和卫生系统改革，对吸引和留住农村卫生工作者的干预措施的设计、实施和有效性都有积极和消极的影响。吸引和留住农村和偏远地区卫生工作者的干预措施需要在整个卫生系统改革中考虑。
