Analysis of strategies to attract and retain rural health workers in Cambodia, China, and Vietnam and context influencing their outcomes

• Published in: Human resources for health Vol. 17; no. 1; p. 2
• Main Authors: Zhu, Anna, Tang, Shenglan, Thu, Nguyen Thi Hoai, Supheap, Leang, Liu, Xiaoyun
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.01.2019; BioMed Central; BMC
• Subjects: Analysis; Attraction and retention; Cambodia; Career Choice; China; Contexts; Delivery of Health Care - methods; Economic development; Economic incentives; GDP; Gross Domestic Product; Health care industry; Health care policy; Health care reform; Health education; Health Facilities; Health Personnel; Health Policy; Health services; Health Services Accessibility; Health Workforce; Healthcare Financing; Hospitals; Human resource management; Humans; Incentives; Intelligence gathering; Low income groups; Medical care utilization; Medical personnel; Medical personnel training; Medical referrals; Monetary incentives; Motivation; National health insurance; Nurses; Patient Acceptance of Health Care; Personnel Management; Personnel Turnover; Physicians; Policy Making; Poverty; Practice; Primary health care; Private Sector; Public hospitals; Reforms; Retention; Rural areas; Rural Health; Rural Health Services; Rural health workers; Rural Population; Shortage and maldistribution; Shortages; Supply and demand; Universal Health Insurance; Urban areas; Vietnam; Workers; Workforce; Cambodia; Vietnam; China; Thailand; Asia; Vietnam; Cambodia; China; Shortage and maldistribution; Attraction and retention; Contexts; Rural health workers
• ISSN: 1478-4491; 1478-4491
• 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.