Bulletin of the World Health Organization

Compulsory service programmes for recruiting health workers in remote and rural areas: do they work?

Seble Frehywot, Fitzhugh Mullan, Perry W Payne & Heather Ross

Volume 88, Number 5, May 2010, 364-370

Table 1. Examples of countries that have compulsory service programmes with incentives

Country Cadre Years of service “Buy out” Incentives to encourage rural posting or retention
Australia Doctor 6 No Scholarship (undergrad), licence to practise (Medicare provider number)
Bolivia (Pluri-national State of) Doctor 1 Yes Graded salary, licence to practise
Ecuador Doctor, dentist, nurse 1 Graded salary, licence to practise, preference for PG specialization, career advancement
Ethiopia Doctor 2–4 Yes Graded salary, preference for PG specialization, degree, textbooks, computer, variable length of service
Ghana Doctor 1–3 Yes a Preference for PG specialization, PG scholarship
Nurse 3 Preference for PG placement
Technician 3 Preference for PG placement
India (Meghalaya) Doctor 3 No Sponsorship to undergraduate training, some undergraduate scholarships, housing
India (Orissa) Doctor 1 No Preference for PG specialization
India (Tamil Nadu) Doctor 3 Yesb Preference for PG specialization, increased preference for every 2 years served in tribal areas.
Specialist 5 Yesb Return of service for PG specialization
Indonesia Doctor < 1–5 Graded salary, preference for PG specialization, career advancement
Kenya Doctor, nurse 3 Licence to practise, preference for PG specialization, PG scholarship, career advancement, various according to locality
Lesotho Doctor 1/year trained No Return of service for training provided overseas, graded salary, housing
Malawi Nurse tutor 2 Scholarship (undergraduate/PG), housing, medical assistance
Mozambique All 2 Housing, career advancement
Mongolia Doctor 2 Degree
Myanmar Doctor, nurse 3 No Graded salary, licence to practise, housing, preference for PG specialization
Namibia Doctor 2 Graded salary, preference for PG scholarships
Nepal Doctor Licence to practise
Nigeria All 1 No Licence to practise, preference for PG specialization, career advancement
Norway Many 1.5 No Licence to practise
Pakistan Doctor 1 Preference for PG training after 3 years in rural area
Peru Doctor 1 Yesc Licence to practise in public sector, preference for PG specialization, PG scholarship, career advancement
South Africa Doctor, dentist, pharmacist 1 Yes Graded salary, licence to practise in private sector
Thailand Doctor 3 Yes Graded salary, preference for PG specialization, housing, career advancement
Turkey 2–4 Graded salary, variable length of service
Viet Nam Doctor 5 Degree
Zambia Doctor 3 Graded salary, housing, child education, loans, preference for PG specialization, PG scholarship
Zimbabwe Doctor 3 Licence to practise, preference for PG specialization

PG, postgraduate

a Ghana’s system of withholding pay cheques from non-compliant personnel means that the equivalent to a “buy out” would be that the health worker accepts no salary.

b Enforced through fine of 1 million rupees (approx. US$ 21 000) which is only affordable to some.

c Health workers may opt to spend their entire career outside Peru’s public sector, such as by emigrating after graduation.

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