Retention of medical doctors and nurses in rural areas of Odisha state, India – a policy analysis

• Pages: 178-196
• Published date: 25 July 2019
• Date: 25 July 2019
• DOI: https://doi.org/10.1108/IJWHM-05-2018-0057
• Author: Manas Ranjan Behera,Chardsumon Prutipinyo,Nithat Sirichotiratana,Chukiat Viwatwongkasem
• Subject Matter: Health & social care

Retention of medical doctors and

nurses in rural areas of Odisha

state, India –a policy analysis

Manas Ranjan Behera

School of Public Health,

Kalinga Institute of Industrial Technology (KIIT) Deemed to be University,

Bhubaneswar, India

Chardsumon Prutipinyo and Nithat Sirichotiratana

Department of Public Health Administration, Faculty of Public Health,

Mahidol University –Rajvithi Campus, Bangkok, Thailand, and

Chukiat Viwatwongkasem

Department of Biostatistics, Faculty of Public Health,

Mahidol University –Rajvithi Campus, Bangkok, Thailand

Abstract

Purpose –Retention of medical doctors and nurses in remote and rural areas is a key issue in India. The

purpose of this paperis to assess the relevant policies and provisions with respect to healthcare professionals,

aiming to develop feasible retention strategies in rural areas of Odisha stateof India.

Design/methodology/approach –The study employed documentary review and key informant interviews

with policy elites (health planners, policy maker, researchers, etc.). The document review included published and

unpublished reports, policy notifications and articles on human resources for health (HRH) in Odisha and similar

settings. Throughout the study, the authors adapted World Health Organization’s framework to study policies

relevant to HRH retention in rural areas. The adapted framework comprised of the four policy domains,

education, regulation, financial incentives, professional and personal support, and 16 recommendations.

Findings –In Odisha,the district quota systemfor admission is not practiced; however, studentsfrom special

tribal and caste (Scheduled Tribe and Scheduled Caste) communities, Socially and Educationally Backward

Classes of citizens, and Persons with Disabilities have some allocated quota to study medicine and nursing.

Medical education has a provision of community placement in rural hospitals. In government jobs, the newly

recruitedmedical doctors serve a minimum of three yearsin rural areas. Doctorsare given with location-based

incentives to work in remote and difficult areas. The government has career development, deployment, and

promotionavenues for doctors and nurses; however,these provisions are notimplemented effectively.

Originality/value –Thegovernment couldaddress the ruralretention problems,as illustratedin the study and

put in placethe most effective policies and provisions towardrecruitment, deployment and attraction of HRH in

remote and rural areas. At the same time, implementation HRH strategies and activities must be rigorously

monitored and evaluated effectively.

Keywords India, Odisha, Policies, Rural retention, Human resources for health

Paper type Research paper

Introduction

Human resources for health (HRH) is one of the six building blocks of health system (WHO,

2006). Approximately 4.2m health worker (physicians, dentists, nurses and midwives)

shortage has been estimated worldwide (WHO, 2008). Globally, there is a positive

correlation between the proportion of the professional health care workforce and key health

outcomes, such as infant and child health, maternal survival, institutional delivery and

International Journal of Workplace

Health Management

Vol. 12 No. 4, 2019

pp. 178-196

© Emerald PublishingLimited

1753-8351

DOI 10.1108/IJWHM-05-2018-0057

Received 5 May 2018

Revised 6 February 2019

Accepted 23 April 2019

The current issue and full text archive of this journal is available on Emerald Insight at:

www.emeraldinsight.com/1753-8351.htm

The authorswould like to thank senior-level stateofficials who took time to be interviewed forthis study.

They also acknowledge the assistance received from Department of Health and Family Welfare

(DOHFW),Odisha and extend their gratitudeto Dr B.P. Mohapatra, Team LeaderState Human Resource

Management Unit, DOHFW-Odisha for their technical inputs and support in data collection process.

178

IJWHM

12,4

immunization (Anand and Barnighausen, 2007). Therefore, bridging this gap is crucial

toward attaining sustainable development goals (WHO, 2008).

Rural and remote populations face disproportionately shortages of HRH. Various

governments, planners, policy makers and ministries of health face herculean tasks in meeting

the exact health needs of rural population (Dolea et al., 2010), mainly due to the scarcity of

health care workers, decreased intentions of staying of HRH in remote locations, and skewed

geographic distribution of rural health care providers (WHO, 2010). Almost all countries in the

world, including rich and poor, report a higher proportion of health care professionals in urban

and city areas (Nigenda and Machado, 2000; Braveman et al., 2001; Behera et al., 2017). This is

mainly due to health workers’preferences for socio-cultural, economic benefits, and the

personal and professional development available only in city areas (Van Lerberghe et al., 2002).

Furthermore, half of the world’s population lives in rural areas, whereas globally 75 percent of

physicians and 62 percent of nurses work in urban areas (World Health Organization and

Global Health Workforce Alliance, 2013). This evidence marks urgent need for an improved

retention of health care professionals especially in rural, remote and underserved locations.

There is a growing body of evidence in the literature on HRH stating different factors

affecting retention level among professionals’health worker in rural areas and low and

middle income countries (Lehmann et al., 2008; Ojakaa et al., 2014; Willis-Shattuck et al.,

2008). A research was conducted in rural hospitals in Zimbabwe to study the determinants

of the retention of health care workers (Nyandoro et al., 2016). This study recommended for

interventions, strategies and proactive measures that address relevant factors that are

important for hospital staffs at different stages of their careers. In fact, interventions that

support health workers to retain them in public hospitals were suggested, which included

packages for career enhancement, introduction in equity in training and development of the

professional health workers.

A research study in Bangladesh reported that difficult living conditions (lack of

drinking water and electricity), poor infrastructure and less career development

opportunitieswerethevitalfactorsobstructing the retention of medical doctors and

nurses (Darkwa et al., 2015). In Vietnam, challenging living conditions (inadequate

infrastructure and limited transportation facilities) were the key factors discouraging

health workforce from working in underserved areas (Dieleman et al., 2003). Likewise, a

study in Tanzania, a self-administered survey was carried out among 70 health care

workers in rural areas revealing that only two were satisfied with infrastructure, two with

equipment facility and another eight were satisfied with their salaries. The study also

highlighted that a limited availability of social support in the work environment

contributed toward not practicing in rural areas (Mbaruku et al., 2009).

In Kenya, two studies have been conducted to assess the factors affecting HRH retention.

The first study was conducted in Trans-Nzoia, Kenya (Butaki, 2015), and it was recognized

that nurses’intention to leave or stay at rural hospitals are influenced by institution’s

capacity to integrate various human resource management practices with the inclusion of

training and development component of medical staffs, effective policies for improving

work–life balance and maintaining congenial working environment. The second study

highlighted the factors affecting motivation and retention of health professionals in three

regions of Kenya (Gikuya, 2014). The study recommended the establishment of policies for

the provision of non-monetary packages, benefits and other feasible interventions that can

support health care staffs to stay in rural areas.

Similarly, one study conducted in Eastern Cape, South Africa, revealed that that poor

working conditions tend to be associated with frustrations among doctors that hinder the

institution’s capacity to retain them in rural health posts (Longmore and Ronnie, 2014).

In the same way, the lack of career development and training opportunities among health

workers leads to frustration that is associated with decrease in the intention to stay of

179

Retention of

medical

doctors

and nurses