Retention Policies For Health Workers In Rural And Remote Areas:an Overview Of Reviews

Objective The shortage of health workers in rural and remote areas has become a significant global health problem, seriously affects the aspirations of achieving health equity for all. However, the research evidence for health workforce retention in rural or remote areas is different in quality, so it is difficult to support health decision-making better. This study uses Evidence-based Medicine (EBM) methods to synthesize and overview the evidence of recruiting and retaining health workers in rural or remote areas. Thus, we would provide evidence reference for health policy researchers and decision makers.Methods Eight electronic databases:PubMed, Cochrane Library, Campbell Library, Web of Science, Chinese Biomedical Database, Chinese Journal Full-text Database, Chinese Scientific Journal Full-text Database and China Science Periodical Database, and the website of the World Health Organization and Google scholar search engines were consulted up to March2014. We also hand searched the reference lists of potential articles. The time of literatures published was not limited. We included systematic reviews which assessed the policy options that could affect the supplying health workers in rural or remote areas. We constructed a comprehensive data extraction included three parts:basic information, reviews characteristics and quality evaluation items, and assessed the quality of each review according to the AMSTAR criteria. The retention policies involved in were synthesized and analysed according to the16recommendations provided by the World Health Organization. Microsoft Excel2003was used to design the data form and performed analyses for the collection data.Results According to inclusion and exclusion criteria, our research identified14systematic reviews, of which,10systematic reviews had been published from2009to2013, accounting for about71.4%;2systematic reviews collected studies from low-and middle-income countries, accounting for about14.3%; and only1(7.1%) systematic reviews included randomized controlled trial. The quality evaluation showed that the methodological quality of the systematic reviews graded into medium (8,57.1%) and low (6,42.9%) respectively. Comprehensive analysis of the evidence showed that, of all policy options. the most systematic reviews focused was clinical rotations in rural areas during studies (6,42.9%). Differently, the research gaps still existed in the options that continuous professional development, enhanced scope of practice, different types of health workers, better living conditions and public recognition measures for rural health workers. At present, there was no systematic review on retention policies other than the16policy recommendations.Conclusions This study shows that the majority of retention policies for health workers in rural and remote areas lack of support by evidence-based research; the amount of available evidence is small, and their methodological quality is poor; they are mainly observational studies, and primarily from high-income countries. That suggests an urgent need to strengthen the research and the consciousness of evidence-based decision making on retention policies for health workers in rural and remote areas, especially in the middle-and low-income countries.