Strategies for Retaining Health-Care Professionals in Rural Areas of India

Retention of skilled health workforce in rural and remote areas is a global problem. While global literature is expanding towards rural retention, however, in the developing countries like India, there is little information available on relevant strategies for implementation of universal healthcare policies and provision of equitable health care distribution. In this review article, the current strategies to retain health-care professionals are generally be grouped into educational, financial, regulatory and supportive strategies. After that, we document and debate two cadres (i.e. physicians and nurses) involved in primary health care in India and the strategies adopted for improved rural retention in these cadres. We also provide ample evidence to support these strategies and analyze their rationale in augmenting health workforce distribution in India. Lastly, we propose pragmatic ways to deal with future human resource for health reforms.

Literature search was conducted in various electronic databases such as Google Scholar, MEDLINE, PUBMED and EMBASE with relevant key words such as doctors, nurses, health workers, health care professionals, human resources for health, etc. Additional studies were also identified through cross-references and websites of official agencies.

We found that, in educational strategy, reservation for post-graduation seats for medical graduates and in-service physicians (doctors currently working in primary health centres) have been employed in various states of India for rural service. The financial incentive strategy includes incentivizing rural service for both medical doctors and nurses. Under regulatory strategies, better workforce management such as transparent posting mechanisms, shorter recruitment procedures and rotational postings in difficult areas have been employed. Apart from this, other types of health workers such rural medical assistants (RMAs) and alternative medicine (Ayurveda, Yoga, Unani, Sidha and Homeopathy)-collectively known as AYUSH have also been trained and recruited for rural health care practice.

In India, rural retention strategies are predominately focused towards physicians. However, state-based evidence and international literature suggest that by providing appropriate financial incentives for rural service to nurses and other cadres such as AYUSH and RMAs is cost-effective and less challenging than the allopathic cadre. Hence, there is an advantage on strengthening rural incentive strategies in these cadres. Further, for these cadres, along with salary, other non-monetary incentives (such as better working conditions, children's education, good rural living conditions and safety) are needed that can increase rural retention.