London School of Hygiene and Tropical Medicine, London, United Kingdom.
World Health Organization Field Office, Awka, Nigeria.
PLoS One. 2022 Mar 29;17(3):e0266159. doi: 10.1371/journal.pone.0266159. eCollection 2022.
Globally, the population in rural communities are disproportionately cared for by only 25% and 38% of the total physicians and nursing staff, respectively; hence, the poor health outcomes in these communities. This condition is worse in Nigeria by the critical shortage of skilled healthcare workforce. This study aimed to explore factors responsible for the uneven distribution of healthcare workers (physicians and nurses) to rural areas of Ebonyi State, Nigeria.
Qualitative data were obtained using semi-structured in-depth interviews and focus group discussions from purposively selected physicians, nurses, and policymakers in the state. Data was analysed for themes related to factors influencing the mal-distribution of healthcare workers (physicians and nurses) to rural areas. The qualitative analysis involved the use of both inductive and deductive reasoning in an iterative manner.
This study showed that there were diverse reasons for the uneven distribution of skilled healthcare workers in Ebonyi State. This was broadly classified into three themes; socio-cultural, healthcare system, and personal healthcare workers' intrinsic factors. The socio-cultural factors include symbolic capital and stigma while healthcare system and governance issues include poor human resources for health policy and planning, work resources and environment, decentralization, salary differences, skewed distribution of tertiary health facilities to urban area and political interference. The intrinsic healthcare workers' factors include career progression and prospect, negative effect on family life, personal characteristics and background, isolation, personal perceptions and beliefs.
There may be a need to implement both non-financial and financial actions to encourage more urban to rural migration of healthcare workers (physicians and nurses) and to provide incentives for the retention of rural-based health workers.
在全球范围内，农村社区的人口分别只有 25%和 38%的医生和护理人员，医护人员分布不均；因此，这些社区的健康状况较差。在尼日利亚，由于熟练医疗保健劳动力的严重短缺，情况更糟。本研究旨在探讨导致医疗工作者（医生和护士）在尼日利亚埃邦伊州农村地区分布不均的因素。
通过半结构化深入访谈和焦点小组讨论，从该州有针对性地选择医生、护士和政策制定者获取定性数据。对与影响医疗工作者（医生和护士）向农村地区分布不均的因素有关的主题进行了数据分析。定性分析包括使用归纳和演绎推理的迭代方法。
这项研究表明，在埃邦伊州，熟练医疗保健工作者分布不均的原因多种多样。这大致分为三个主题；社会文化、医疗保健系统和个人医疗保健工作者的内在因素。社会文化因素包括象征资本和耻辱感，而医疗保健系统和治理问题包括人力资源政策和规划不佳、工作资源和环境、权力下放、工资差异、三级卫生设施向城市地区的倾斜分布以及政治干预。医疗保健工作者内在因素包括职业发展和前景、对家庭生活的负面影响、个人特征和背景、孤立、个人看法和信念。
可能需要采取非财务和财务行动来鼓励更多的城市向农村地区迁移医疗工作者（医生和护士），并为农村地区的卫生工作者提供留任激励。
