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Developing effective policy strategies to retain health workers in rural Bangladesh: a policy analysis

机译：制定有效的政策战略以留住孟加拉国农村地区的卫生工作者：一项政策分析

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Introduction 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. Methods 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. Results 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. Conclusion 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.
机译：引言卫生人力资源的保留，特别是农村和边远地区的医生和护士，是孟加拉国的一个主要问题。我们审查了有关HRH的相关政策和规定，旨在制定孟加拉国适当的农村保留策略。方法我们对文件进行审查，对1971年至2013年5月间发表的相关文献进行全面检索和审查，对政策精英（卫生政策制定者，管理人员，研究人员等）进行关键知情人访谈，并与主要利益相关者和决策者进行圆桌讨论。我们使用世界卫生组织（WHO）的指南作为分析矩阵，研究了以下四个领域的农村保留政策：i）教育，ii）监管，iii）财务，iv）专业和个人发展以及16个子领域。结果在过去的四十年中，孟加拉国制定并实施了许多与保留HRH有关的健康相关政策和规定。招生中的分区配额制度实际上是为了提高学生的地域代表性。具有特殊背景的学生（包括自由战士的孩子和部落人口）已分配配额。在私立医护学校，至少有5％的席位分配给奖学金。医学教育为农村医疗机构的临床轮换提供了条件。此外，在公共部门，每位新招募的医生必须在upazila级别至少服务2年。为了鼓励在难以到达的地区服务，特别是在吉大港县的三个山区地区，政府额外提供基本工资的33％，但每月不超过38美元。这一数额不够吸引人，而在其他农村地区工作的人则没有这种拨款。尽管政府为医生和护士制定了职业发展和晋升计划，但这些计划通常没有明确规定，也没有得到有效实施。结论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。但是，孟加拉国需要更有效的政策和规定，专门针对农村地区的HRH的吸引，部署和保留，必须对这些政策和规定的执行情况进行有效的监控和评估。

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