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Skilled and motivated health workers in sufficient numbers at the right place and at the right time are critical to deliver effective services and improve health outcomes (WHO 2010). However, a shortage of qualified health workers in rural areas is common in both developed and developing countries. In most developing countries in the world more than half of their populations live in rural areas. The shortage is more pronounced in the 57 countries that the World Health Report of 2006 categorizes as being in a human resources for health crisis (WHO 2006). Globally, rural areas are served by only 38% of the total nursing workforce and by less than a quarter of the total physician workforce (figure 1). An estimated 1 billion people worldwide do not have access to health workers.

The shortage of qualified human resources in low- and middle-income countries impedes access to health-care services for a significant percentage of the population, slows progress toward the Millennium Development Goals, and challenges the aspirations of achieving health for all (WHO 2010).

In 2010 the World Health Organization launched global policy recommendations on increasing access to health workers in remote and rural areas through improved retention of workers (WHO,2010). These recommendations provide evidence-based guidelines on the effectiveness of interventions that can increase attraction, recruitment, and retention of health workers in remote and rural areas. The World Health Organization, the World Bank, and CapacityPlus (USAID’s flagship global human resources for health project) are producing a road map for implementing the global recommendations. The road map will contain tools to help design, select, implement, monitor, and evaluate rural retention strategies. As well as this user guide, the road map will include a decision tool to choose the most appropriate strategies, a costing tool, and a monitoring and evaluation framework.

This guide aims to provide easy-to-read information and step-by-step advice on a quantitative research method that can help identify appropriate policy responses to health workforce shortages in remote and rural areas. This method can provide policy makers with quantitative measures of the relative importance of different job characteristics that influence the choice of health workers for rural postings.

The guide gives details about the types of questions such a method can (or cannot) answer, and the type of data, analysis, and analytical skills required to perform the research. It will use two case studies to illustrate the challenges and the ways to overcome them in conducting the work. Finally, it will provide information on the logistical and scientific requirements to perform such research and will offer links to resources for more detailed scientific and academic materials that can be consulted by advanced researchers.

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Author/s: World Bank, Capacity Plus, USAID, WHO
Date of Publication: January 2012

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