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.