Incentives to attract and retain qualified health workers to under-served areas within low- and middle-income countries
Can doctors be replaced? Evaluating incentives and performance of different cadres of primary health care providers in rural India.
The geographic distribution of India’s health workforce is highly uneven. Most (60%) health workers live in urban areas, where only 28% of the population resides. To address this imbalance, several states in India have experimented with using different cadres of health workers to provide basic clinical services in rural primary health centers (PHC). These include, contracting private doctors, Indian systems of medicine physicians (AYUSH) and paramedical staff (nurses, pharmacists and medical assistants). Little, however, is known about the success of these alternatives.
The objectives of this study are (a) to document incentives offered by the major states in India to recruit and retain different cadres of health workers at rural health facilities; (b) to compare the performance of PHCs headed by AYUSH physicians, contractual doctors and paramedical staff with those run by regularised government medical doctors; and (c) to understand the factors influencing the decision of health workers to serve in rural areas. The performance of PHCs in each group will be examined on technical quality, patient perceived quality, provider satisfaction utilization of services, and the range of cases treated. The study will be carried out in Chhattisgarh State.
Findings from this study will help in addressing the problem of recruiting and retaining qualified health workers in underserved areas. By systematically documenting existing incentives across states this study will provide an understanding of the range of incentives that states have introduced to place health workers in rural areas. Importantly, this study will assess the effectiveness of current policies that seek to place contractual doctors, AYUSH physicians or paramedical staff at PHCs. These findings may well inform new policy directions for training of health personnel for PHCs, which could include task-shifting strategies.
Project description
Programme:Incentives to attract and retain qualified health workers to under-served areas within low- and middle-income countries
Research title: Can doctors be replaced? Evaluating incentives and performance of different cadres of primary health care providers in rural India.
Thematic Research Area: Human Resources for Health
Grantee Country: India
Grantee Institution:Public Health Foundation of India
Program Coordinator/Principle Investigator: Dr Krishna Dipankar Rao
Start date: March 2009
Status of grant: Completed