For more than love or money: attitudes of student and in-service health workers towards rural service in India

Human Resources for Health

Peter Berman¹  Marko Vujicic²  Mandy Ryan⁵  Krishna D Rao³  Sudha Ramani⁴ 

[1] Department of Global Health and Population, Harvard University, 665 Huntington Avenue, Building I, 11th Floor, Boston, Massachusetts 02115, USA;Human Development Network, The World Bank, 1818 H Street, NW, Washington DC 20433, USA;Public Health Foundation of IndiaISID Campus, 4 Institutional Area, Vasant Kunj, New Delhi 110070, India;Indian Institute of Public Health, Hyderabad, Plot # 1, A N V Arcade, Amar Co-operative Society, Kavuri Hills, Madhapur, Hyderabad 500 081, India;Health Economics Research Unit, Division of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, Scotland

关键词: India;    Primary healthcare;    Rural recruitment;    Rural retention;    Incentives;    Human resources;   

Others  :  822190
DOI  :  10.1186/1478-4491-11-58

 received in 2013-03-26, accepted in 2013-11-06,  发布年份 2013

【 摘 要 】

Background

While international literature on rural retention is expanding, there is a lack of research on relevant strategies from pluralistic healthcare environments such as India, where alternate medicine is an integral component of primary care. In such contexts, there is a constant tug of war in national policy on “Which health worker is needed in rural areas?” and “Who can, realistically, be got there?” In this article, we try to inform this debate by juxtaposing perspectives of three cadres involved in primary care in India—allopathic, ayurvedic and nursing—on rural service. We also identify key incentives for improved rural retention of these cadres.

Methods

We present qualitative evidence from two states, Uttarakhand and Andhra Pradesh. Eighty-eight in-depth interviews with students and in-service personnel were conducted between January and July 2010. Generic thematic analysis techniques were employed, and the data were organized in a framework that clustered factors linked to rural service as organizational (salary, infrastructure, career) and contextual (housing, children’s development, safety).

Results

Similar to other studies, we found that both pecuniary and non-pecuniary factors (salary, working conditions, children’s education, living conditions and safety) affect career preferences of health workers. For the allopathic cadre, rural primary care jobs commanded little respect; respondents from this cadre aimed to specialize and preferred private sector jobs. Offering preferential admission to specialist courses in exchange for a rural stint appears to be a powerful incentive for this cadre. In contrast, respondents from the Ayurvedic and nursing cadres favored public sector jobs even if this meant rural postings. For these two cadres, better salary, working and rural living conditions can increase recruitment.

Conclusions

Rural retention strategies in India have predominantly concentrated on the allopathic cadre. Our study suggests incentivizing rural service for the nursing and Ayurvedic cadres is less challenging in comparison to the allopathic cadre. Hence, there is merit in strengthening rural incentive strategies for these two cadres also. In our study, we have developed a detailed framework of rural retention factors and used this for delineating India-specific recommendations. This framework can be adapted to other similar contexts to facilitate international cross-cadre comparisons.

【 授权许可】

   
2013 Ramani et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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