Bulletin of the World Health Organization

Increasing access to health workers in underserved areas: a conceptual framework for measuring results

Luis Huicho, Marjolein Dieleman, James Campbell, Laurence Codjia, Dina Balabanova, Gilles Dussault & Carmen Dolea

Volume 88, Number 5, May 2010, 357-363

Table 2. Proposed questions and indicators for the evaluation and monitoring of interventions to increase access to health workers in underserved areas

Stage Questions Indicators Methods
Design • Did the intervention respond to a documented need?
• Is the choice of the intervention based on evidence or robust arguments (situation analysis)?
• Were the actual reasons for limited access to health workers clearly documented (i.e. insufficient number of students willing to work in rural areas or insufficient number of funded positions?
• Human resources for health-costed plan, including situation analysis
• Stocks and flows of health workers (for more details see reference)8
• Labour market analysis
• Survey of intentions
• Demographic analysis (health workforce stocks and flows)
• Stakeholder analysis
• Review of policy documents
Implementation • Did the activities take place according to plan?
• Did any changes occur during implementation?
• Process indicators (changes in the programme elements) • Surveys
• Stakeholder analysis
• Review of policy documents
Results • Did attractiveness of profession/rural/remote areas improve?
• Did recruitment of health workers in underserved areas improve?
• Did retention improve?
• Total health workers recruited
• Changes in preferences for rural/remote areas
• Reduced turnover
• Reduced vacancies
• Stability index
• Survival rates (or years in post)
• Surveys
• Survival analysis
• Analysis of registries data or facility data
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