Retention of the health workforce in rural and remote areas: a systematic review

Rural populations across the globe continue to face health, economic and social inequities. A major contributor to pervasive health inequalities in rural and remote areas is a shortage of available, appropriate and motivated health workers. Compounding this, the COVID-19 pandemic’s health, health systems and socio-economic impacts threaten to worsen the health outcomes of the more vulnerable rural populations.

Owing to partnership and the commitment and contributions of 35 reviewers with expertise in rural health workforce as researchers or practitioners. And to dialogue, notably at the Global Forum on Human Resources for Health in Dublin in 2017 and the WONCA World Rural Health Conference in India in 2018. WHO is able to launch a synthesis of recent evidence to see what has worked, and what has not, to attract, develop, recruit and retain health workers in rural and remote areas.

This review “The Retention of the health workforce in rural and remote areas: a systematic review assesses the evolution of evidence in the decade that has passed since the global policy recommendations were released and builds on the work previously undertaken to develop the WHO’s 2010 Global policy recommendations: Increasing access to health workers in remote and rural areas through improved retention.

The context and research base has greatly evolved since 2010 – over 100 new studies – across a wider array of health worker occupations and countries now form the evidence base. This larger evidence is critical to informing effective policy approaches to redress rural health workforce gaps.

The review also examines the recurring factors that influence attraction, development, recruitment, and retention of health workers in rural areas, emphasizing important considerations such context, occupation and career stage of workers which influence the outcomes of interventions. Also highlighted are the impacts of an optimally engaged community and sustainable health systems, or lack thereof on the outcomes of interest. The review also underscores the need for an appropriate bundle of interventions to address the factors that influence the availability and performance of health workers.

It reiterates that for rural populations, the universal truths: no health without a health workforce and achieving universal health coverage implies leaving no one behind, call to attention the need to rapidly increase efforts to close the gap to in access to health workers and has direct and indirect implications on the timely achievement of the Sustainable Development Goals. (WHO.int)