Developing effective policy strategies to retain health workers in rural Bangladesh: a policy analysis.
Developing effective policy strategies to retain health workers in rural Bangladesh: a policy analysis.
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DOI：
10.1186/s12960-015-0030-6
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发表时间：
2015-05-20
影响因子：
4.5
通讯作者：
Ahmed SM
中科院分区：
文献类型：
--
作者：
Rawal LB;Joarder T;Islam SM;Uddin A;Ahmed SM
在孟加拉国，留住卫生人力资源，特别是农村和偏远地区的医生和护士，是一个主要问题。我们审查了与人力资源相关的相关政策和规定，旨在制定孟加拉国适当的农村保留战略。我们对1971年至2013年5月发表的相关文献进行了文献回顾、全面检索和审查，对政策精英（卫生政策制定者、管理者、研究人员等）进行了关键信息人访谈，以及与主要利益攸关方和决策者举行圆桌讨论会。我们使用世界卫生组织（WHO）的指导方针作为分析矩阵，在4个领域（i）教育，ii）监管，iii）金融，iv）专业和个人发展以及16个子领域下检查农村保留政策。在过去40年中，孟加拉国制定并实施了一些与卫生有关的政策和保留人力资源的规定。在招生方面实行地区配额制度，以改善学生的地域代表性。有特殊背景的学生，包括自由战士和部落居民的子女，都有配额。在私立医学院和护士学校，至少5%的席位分配给奖学金。医学教育规定在农村卫生设施进行临床轮换。此外，在公共部门，每名新招聘的医生必须在乡一级至少服务两年。为了鼓励在偏远地区，特别是在吉大港省的三个山区地区服务，政府额外提供基本工资的33%，但每月不超过38美元。这一数额没有足够的吸引力，在其他农村地区工作的人也没有这种规定。虽然政府有医生和护士的职业发展和晋升计划，但这些计划往往没有明确规定，也没有有效执行。政府致力于通过制定和实施相关政策和战略来解决农村保留问题。然而，孟加拉国需要更有效的政策和规定，专门为吸引，部署和保留农村地区的人力资源，这些政策和规定的执行必须得到有效的监测和评估。
Retention of human resources for health (HRH), particularly physicians and nurses in rural and remote areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to develop appropriate rural retention strategies in Bangladesh. We conducted a document review, thorough search and review of relevant literature published from 1971 through May 2013, key informant interviews with policy elites (health policy makers, managers, researchers, etc.), and a roundtable discussion with key stakeholders and policy makers. We used the World Health Organization’s (WHO’s) guidelines as an analytical matrix to examine the rural retention policies under 4 domains, i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and 16 sub-domains. Over the past four decades, Bangladesh has developed and implemented a number of health-related policies and provisions concerning retention of HRH. The district quota system in admissions is in practice to improve geographical representation of the students. Students of special background including children of freedom fighters and tribal population have allocated quotas. In private medical and nursing schools, at least 5% of seats are allocated for scholarships. Medical education has a provision for clinical rotation in rural health facilities. Further, in the public sector, every newly recruited medical doctor must serve at least 2 years at the upazila level. To encourage serving in hard-to-reach areas, particularly in three Hill Tract districts of Chittagong division, the government provides an additional 33% of the basic salary, but not exceeding US$ 38 per month. This amount is not attractive enough, and such provision is absent for those working in other rural areas. Although the government has career development and promotion plans for doctors and nurses, these plans are often not clearly specified and not implemented effectively. The government is committed to address the rural retention problem as shown through the formulation and implementation of related policies and strategies. However, Bangladesh needs more effective policies and provisions designed specifically for attraction, deployment, and retention of HRH in rural areas, and the execution of these policies and provisions must be monitored and evaluated effectively.