Health Worker Attitudes toward Rural Service in India : Results from Qualitative Research
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World Bank, Washington, DC
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The paucity of qualified health workers
in rural areas is a critical challenge for India's
health sector. Although state governments have instituted
several mechanisms, salary and non-salary, to attract health
workers to rural areas, individually these mechanisms
typically focus on single issues (e.g. salary). This
qualitative study explores the career preferences of
under-training and in-service doctors and nurses and
identifies factors important to them to take up rural
service. It then develops a framework for clustering these
complex attributes into potential ?incentive packages for
better rural recruitment and retention. The study was
carried out in two geographically diverse Indian states,
Uttarakhand and Andhra Pradesh. A total of 80 in-depth
interviews were conducted with a variety of participants:
medical students (undergraduate, postgraduate, and Indian
system of medicine), nursing students, and doctors and
nurses in primary health centers. The information collected
was clustered by constructing several hierarchical displays,
and collated into job-attribute matrixes. The findings
indicate that, while financial and educational incentives
attract doctors and nurses to rural postings, they do not
make effective retention strategies. Frustration among rural
health workers often stems from the lack of infrastructure,
support staff, and drugs, a feeling exasperated by local
political interference and lack of security.
Palabras clave
ACCREDITATION, BUS SERVICE, BUSES, CAR, CAREER, CAREER PROSPECTS, CAREERS, CLEANLINESS, COLLEGES, COMMUNITIES, DECISION MAKING, DESCRIPTION, DISEASES, DRAINAGE, DRUGS, ELDERLY, EMERGENCIES, EMPLOYMENT, EQUAL OPPORTUNITIES, FAMILIES, FAMILY WELFARE, FEMALE, FEMALE STUDENTS, FURTHER EDUCATION, GENDER, GEOGRAPHIC DISTRIBUTION, GYNECOLOGY, HEALTH CENTERS, HEALTH FACILITIES, HEALTH POLICY, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SYSTEM, HEALTH WORKERS, HIGHER EDUCATION, HIGHER EDUCATION OPPORTUNITIES, HOMEOPATHY, HOSPITAL, HOSPITALS, HOUSEHOLDS, HOUSING, HOUSING CONDITIONS, HUMAN DEVELOPMENT, HUMAN RESOURCES, HUSBANDS, HYGIENE, ILLITERACY, IMMUNIZATION, ISOLATION, JOB MARKET, JOB SATISFACTION, JOB SECURITY, LANGUAGE BARRIERS, LEARNING, LEARNING OPPORTUNITIES, LEGAL PROTECTION, LEVEL OF EDUCATION, LIVING CONDITIONS, LOCAL TRANSPORT, MARITAL STATUS, MEDICAL COLLEGE, MEDICAL COLLEGES, MEDICAL DOCTORS, MEDICAL FACILITIES, MEDICAL PERSONNEL, MEDICAL PROFESSIONALS, MEDICAL SCHOOLS, MEDICAL SPECIALISTS, MEDICAL STUDENTS, MEDICINES, MIDWIFE, MIDWIFERY, MINISTRY OF HEALTH, NURSE, NURSES, NURSING, NURSING SCHOOLS, NURSING STUDENTS, NUTRITION, ON THE JOB TRAINING, ON THE JOB · TRAINING, PAPERS, PATIENT, PATIENTS, PEDIATRICS, PENSIONS, PERSONAL SAFETY, PHYSICAL WORK, POLICY PROCESSES, POLICY RESPONSE, POOR HEALTH, POOR HOUSING, POSTGRADUATE STUDENTS, POSTGRADUATE STUDIES, PRACTITIONERS, PRIMARY HEALTH CARE, PRIVATE SCHOOLS, PROFESSIONAL DEVELOPMENT, PROVIDER ATTITUDES, PUBLIC HEALTH, PUBLIC SERVICE, PUBLIC TRANSPORT, RECREATION, RESEARCH OPPORTUNITIES, RESPECT, ROAD, ROAD CONDITIONS, ROADS, RURAL AREA, RURAL AREAS, RURAL DEVELOPMENT, SAFETY OF WOMEN, SANITATION, SCHOOL BUS, SCHOOLS, SERVICE PROVIDER, SERVICE PROVIDERS, SICK LEAVE, SKILL DEVELOPMENT, SMALLER NUMBER, SPOUSE, STATE GOVERNMENTS, SUPERMARKETS, SUPPORT TO PARENTS, SURGERY, TEACHERS, TEACHING, TELEVISION, TOWNS, TRAINING HEALTH WORKERS, TRAINING OPPORTUNITIES, TRANSPORT, TRANSPORT FACILITIES, TV, UNDERGRADUATE STUDENTS, UNDERGRADUATES, URBAN AREA, URBAN AREAS, URBAN CENTER, VACCINES, VEHICLE, VIOLENCE, VULNERABILITY, WALKING, WASTE, WORK ENVIRONMENT, WORKERS, WORKFORCE, WORKING CONDITIONS, YOUNG CHILDREN