Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.
Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
J Public Health (Oxf). 2021 Apr 13;43(Suppl 1):i54-i66. doi: 10.1093/pubmed/fdaa235.
Global health workforce shortages exist with disparities in the skill mix and distribution of health workers. Rural and underserved populations are often disadvantaged in terms of access to health care.
This systematic review summarized all systematic reviews that assessed interventions for improving attraction and retention of health workers in rural and underserved areas. We systematically searched selected electronic databases up to 31 March 2020. The authors independently screened the reviews, extracted data and assessed the certainty of evidence using GRADE. Review quality was assessed using the ROBIS tool.
There was a paucity of evidence for the effectiveness of the various interventions. Regulatory measures were able to attract health workers to rural and underserved areas, particularly when obligations were attached to incentives. However, health workers were likely to relocate from these areas once their obligations were completed. Recruiting rural students and rural placements improved attraction and retention although most studies were without control groups, which made conclusions on effectiveness difficult.
Cost-effective utilization of limited resources and the adoption and implementation of evidence-based health workforce policies and interventions that are tailored to meet national health system contexts and needs are essential.
全球卫生人力短缺，卫生工作者的技能组合和分布存在差异。农村和服务不足地区的人群在获得医疗保健方面往往处于不利地位。
本系统评价总结了所有评估吸引和留住农村和服务不足地区卫生工作者的干预措施的系统评价。我们系统地检索了截至 2020 年 3 月 31 日的选定电子数据库。作者独立筛选了这些综述，提取数据，并使用 GRADE 评估证据的确定性。使用 ROBIS 工具评估综述质量。
各种干预措施的有效性证据很少。监管措施能够吸引卫生工作者到农村和服务不足地区，特别是当激励措施与义务挂钩时。然而，一旦卫生工作者完成了义务，他们很可能会从这些地区重新安置。招募农村学生和农村实习可以提高吸引力和保留率，尽管大多数研究没有对照组，这使得关于有效性的结论变得困难。
有效利用有限资源，以及采用和实施针对国家卫生系统背景和需求的循证卫生人力政策和干预措施至关重要。
