Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomes
Abstract Background 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...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-01-01
|
| Series: | Human Resources for Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12960-018-0340-6 |
| _version_ | 1818921844739145728 |
|---|---|
| author | Anna Zhu Shenglan Tang Nguyen Thi Hoai Thu Leang Supheap Xiaoyun Liu |
| author_facet | Anna Zhu Shenglan Tang Nguyen Thi Hoai Thu Leang Supheap Xiaoyun Liu |
| author_sort | Anna Zhu |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-12-20T01:44:06Z |
| format | Article |
| id | doaj.art-990b6d00c5624503b3da9a34b08819ad |
| institution | Directory Open Access Journal |
| issn | 1478-4491 |
| language | English |
| last_indexed | 2024-12-20T01:44:06Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Human Resources for Health |
| spelling | doaj.art-990b6d00c5624503b3da9a34b08819ad2022-12-21T19:57:49ZengBMCHuman Resources for Health1478-44912019-01-011711910.1186/s12960-018-0340-6Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomesAnna Zhu0Shenglan Tang1Nguyen Thi Hoai Thu2Leang Supheap3Xiaoyun Liu4Global Health Research Center, Duke Kunshan UniversityGlobal Health Research Center, Duke Kunshan UniversityDepartment of Health Management and Organization, Hanoi Medical UniversityTechnical Bureau, National Institute of Public HealthChina Centre for Health Development Studies, Peking UniversityAbstract Background 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. Methods 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. Results 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. Conclusions 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.http://link.springer.com/article/10.1186/s12960-018-0340-6ContextsShortage and maldistributionAttraction and retentionRural health workersChinaVietnam |
| spellingShingle | Anna Zhu Shenglan Tang Nguyen Thi Hoai Thu Leang Supheap Xiaoyun Liu Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomes Human Resources for Health Contexts Shortage and maldistribution Attraction and retention Rural health workers China Vietnam |
| title | Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomes |
| title_full | Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomes |
| title_fullStr | Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomes |
| title_full_unstemmed | Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomes |
| title_short | Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomes |
| title_sort | analysis of strategies to attract and retain rural health workers in cambodia china and vietnam and context influencing their outcomes |
| topic | Contexts Shortage and maldistribution Attraction and retention Rural health workers China Vietnam |
| url | http://link.springer.com/article/10.1186/s12960-018-0340-6 |
| work_keys_str_mv | AT annazhu analysisofstrategiestoattractandretainruralhealthworkersincambodiachinaandvietnamandcontextinfluencingtheiroutcomes AT shenglantang analysisofstrategiestoattractandretainruralhealthworkersincambodiachinaandvietnamandcontextinfluencingtheiroutcomes AT nguyenthihoaithu analysisofstrategiestoattractandretainruralhealthworkersincambodiachinaandvietnamandcontextinfluencingtheiroutcomes AT leangsupheap analysisofstrategiestoattractandretainruralhealthworkersincambodiachinaandvietnamandcontextinfluencingtheiroutcomes AT xiaoyunliu analysisofstrategiestoattractandretainruralhealthworkersincambodiachinaandvietnamandcontextinfluencingtheiroutcomes |