1932

Abstract

Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status. Nowhere is the worldwide shortage of health professionals more pronounced than in rural areas of developing countries. Sub-Saharan Africa (SSA) includes a disproportionately large number of developing countries; therefore, this article explores SSA in depth as an example. Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from underserviced areas to deliver quality health care in rural community settings.

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2016-03-18
2024-04-18
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Literature Cited

  1. Aarnio P, Chipeta E, Kulmala T. 1.  2013. Men's perceptions of delivery care in rural Malawi: exploring community level barriers to improving maternal health. Health Care Women Int. 34:419–39 [Google Scholar]
  2. Adogu PO, Egenti BN, Ubajaka C, Onwasigwe C, Nnebue CC. 2.  2014. Utilization of maternal health services in urban and rural communities of Anambra State, Nigeria. Niger. J. Med. 23:61–69 [Google Scholar]
  3. 3. Afr.-EU Partnersh 2015. Telemedicine services to Sub-Saharan Africa. Afr.-EU Partnersh., Brussels. http://www.africa-eu-partnership.org/success-stories/telemedicine-services-sub-saharan-africa
  4. Amoran OE, Omokhodion FO, Dairo MD, Adebayo AO. 4.  2005. Job satisfaction among primary health care workers in three selected local government areas in Southwest Nigeria. Niger. J. Med. 14:195–99 [Google Scholar]
  5. Angwenyi V, Kamuya D, Mwachiro D, Kalama B, Marsh V. 5.  et al. 2014. Complex realities: community engagement for a paediatric randomized controlled malaria vaccine trial in Kilifi, Kenya. Trials 15:65 [Google Scholar]
  6. Anyamele OD. 6.  2009. Urban and rural differences across countries in child mortality in sub-Saharan Africa. J. Health Care Poor Underserved 20:90–98 [Google Scholar]
  7. Anyangwe S, Mtonga C. 7.  2007. Inequities in the global health workforce: the greatest impediment to health in sub-Saharan Africa. Int. J. Environ. Res. Public Health 4:93–100 [Google Scholar]
  8. Atun RA, Bennett S, Duran A. 8.  2008. When do vertical (stand-alone) programmes have a place in health systems? Policy Brief, WHO, Eur. Obs. Health Syst. Policies, Copenhagen, Den. http://www.who.int/management/district/services/WhenDoVerticalProgrammesPlaceHealthSystems.pdf [Google Scholar]
  9. Awofeso N. 9.  2010. Improving health workforce recruitment and retention in rural and remote regions of Nigeria. Rural Remote Health 10:1319 [Google Scholar]
  10. Awoonor-Williams JK, Feinglass ES, Tobey R, Vaughan-Smith MN, Nyonator FK, Jones TC. 10.  2004. Bridging the gap between evidence-based innovation and national health-sector reform in Ghana. Stud. Fam. Plan. 35:161–77 [Google Scholar]
  11. Baatiema L, Skovdal M, Rifkin S, Campbell C. 11.  2013. Assessing participation in a community-based health planning and services programme in Ghana. BMC Health Serv. Res. 13:233 [Google Scholar]
  12. Baicker K, Chandra A. 12.  2004. Medicare spending, the physician workforce, and beneficiaries' quality of care. Health Aff. (Millwood) Jan.–Jun.:Suppl. Web Exclus.W4184–97 [Google Scholar]
  13. Bateman C. 13.  2012. “One size fits all” health policies crippling rural rehab-therapists. S. Afr. Med. J. 102:200 [Google Scholar]
  14. Bendavid E, Bhattacharya J. 14.  2014. The relationship of health aid to population health improvements. JAMA Intern. Med. 174:881–87 [Google Scholar]
  15. Blaauw D, Erasmus E, Pagaiya N, Tangcharoensathein V, Mullei K. 15.  et al. 2010. Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment. Bull. World Health Organ. 88:350–56 [Google Scholar]
  16. Boelen C, Woollard B. 16.  2009. Social accountability and accreditation: a new frontier for educational institutions. Med. Educ. 43:887–94 [Google Scholar]
  17. Boelen C, Woollard R. 17.  2010. Global consensus for social accountability of medical schools Rep., Glob. Consens. Soc. Account., Vancouver, Can. http://healthsocialaccountability.sites.olt.ubc.ca/files/2011/06/11-06-07-GCSA-English-pdf-style.pdf
  18. Boelen C, Woollard R. 18.  2011. Social accountability: the extra leap to excellence for educational institutions. Med. Teach. 33:614–19 [Google Scholar]
  19. Bushy A, Leipert BD. 19.  2005. Factors that influence students in choosing rural nursing practice: a pilot study. Rural Remote Health 5:387 [Google Scholar]
  20. Buykx P, Humphreys J, Wakerman J, Pashen D. 20.  2010. Systematic review of effective retention incentives for health workers in rural and remote areas: towards evidence-based policy. Aust. J. Rural Health 18:102–9 [Google Scholar]
  21. Campbell J, Dussault G, Buchan J, Pozo-Martin F, Guerra Arias M. 21.  et al. 2013. A Universal Truth: No Health Without a Workforce. Geneva: WHO, Glob. Health Workforce Alliance
  22. Campbell PC, Ebuehi OM. 22.  2011. Job satisfaction: rural versus urban primary health care workers' perception in Ogun State of Nigeria. West Afr. J. Med. 30:408–12 [Google Scholar]
  23. Chan BT, Degani N, Crichton T, Pong RW, Rourke JT. 23.  et al. 2005. Factors influencing family physicians to enter rural practice: Does rural or urban background make a difference?. Can. Fam. Phys. 51:1246–47 [Google Scholar]
  24. Chan M. 24.  2009. Primary health care as a route to health security. Lancet 373:1586–87 [Google Scholar]
  25. Chen L, Evans T, Anand S, Boufford JI, Brown H. 25.  et al. 2004. Human resources for health: overcoming the crisis. Lancet 364:1984–90 [Google Scholar]
  26. 26. Comm. Soc. Determinants Health 2008. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva: WHO http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf
  27. Cristobal F, Worley P. 27.  2011. Transforming health professionals' education. Lancet 377:1235–36 [Google Scholar]
  28. Cristobal F, Worley P. 28.  2012. Can medical education in poor rural areas be cost-effective and sustainable: the case of the Ateneo de Zamboanga University School of Medicine. Rural Remote Health 12:1835 [Google Scholar]
  29. Daniels ZM, VanLeit BJ, Skipper BJ, Sanders ML, Rhyne RL. 29.  2007. Factors in recruiting and retaining health professionals for rural practice. J. Rural Health 23:62–71 [Google Scholar]
  30. Derbew M, Animut N, Talib ZM, Mehtsun S, Hamburger EK. 30.  2014. Ethiopian medical schools' rapid scale-up to support the government's goal of universal coverage. Acad. Med. 89:S40–44 [Google Scholar]
  31. Dominick A, Kurowski C. 31.  2005. Human resources for health: an appraisal of the status quo in Tanzania mainland Rep., World Bank, Ifakara Health Res. Dev. Cent., London Sch. Hyg. Trop. Med., Washington, DC. http://info.worldbank.org/etools/docs/library/206771/TZ%20HRH%20CP1%20Reportappraisal%20final%20version%20January%202005.pdf
  32. Dussault G, Fronteira I, Prytherch H, Dal Poz MR, Ngoma D. 32.  et al. 2009. Scaling up the stock of health workers: a review. Rep., Int. Cent. Hum. Resour. Nurs., Geneva. http://www.healthworkforce4europe.eu/downloads/3._Dussault_G,_et_al._Scaling_up_the_stock_of_health_workers.pdf [Google Scholar]
  33. Eckhert N. 33.  2002. The global pipeline: too narrow, too wide or just right?. Med. Educ. 36:606–13 [Google Scholar]
  34. 34. Eur. Space Agency 2006. Telemedicine initiative for sub-Saharan Africa. Paris: Eur. Space Agency http://www.esa.int/Our_Activities/Telecommunications_Integrated_Applications/Telemedicine_initiative_for_sub-Saharan_Africa
  35. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N. 35.  et al. 2010. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 376:1923–58 [Google Scholar]
  36. Friedberg MW, Hussey PS, Schneider EC. 36.  2010. Primary care: a critical review of the evidence on quality and costs of health care. Health Aff. (Millwood) 29:766–72 [Google Scholar]
  37. Gabrysh S, Campbell OMR. 37.  2009. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 9:1–18 [Google Scholar]
  38. Goosby EP, von Zinkernagel DSM. 38.  2014. The medical and nursing education partnership initiatives. Acad. Med. 89:S5–7 [Google Scholar]
  39. Goudge J, Gilson L, Russell S, Gumede T, Mills A. 39.  2009. The household costs of health care in rural South Africa with free public primary care and hospital exemptions for the poor. Trop. Med. Int. Health 14:458–67 [Google Scholar]
  40. Grobler L, Marais BJ, Mabunda SA, Marindi PN, Reuter H, Volmink J. 40.  2009. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst. Rev. 1:CD005314 [Google Scholar]
  41. Hancock C, Steinbach A, Nesbitt TS, Adler SR, Auerswald CL. 41.  2009. Why doctors choose small towns: a developmental model of physician recruitment and retention. Soc. Sci. Med. 69:1368–76 [Google Scholar]
  42. Hongoro C, McPake B. 42.  2004. How to bridge the gap in human resources for health. Lancet 364:1451–56 [Google Scholar]
  43. 43. Inst. Popul. Soc. Res 2015. Report on the 2015 Conference on Global Health Post 2015: Accelerating Equity. Prince Mahidol Award Conference 2015, January 26–31, 2015, Bangkok, Thailand. Nakhon Patham, Thail.: Inst. Popul. Soc. Res.
  44. 44. Int. Stat. Inst 2015. Developing countries. Int. Stat. Inst., The Hague, Neth. http://www.isi-web.org/index.php/resources/developing-countries
  45. Jutzi L, Vogt K, Drever E, Nisker J. 45.  2009. Recruiting medical students to rural practice: perspectives of medical students and rural recruiters. Can. Fam. Physician 55:172–73.e4 [Google Scholar]
  46. Kahabuka C, Kvale G, Moland KM, Hinderaker SG. 46.  2011. Why caretakers bypass primary health care facilities for child care: a case from rural Tanzania. BMC Health Serv. Res. 11:315 [Google Scholar]
  47. Kaye DK, Mwanika A, Sewankambo N. 47.  2010. Influence of the training experience of Makerere University medical and nursing students on willingness and competence to work in rural health facilities. Rural Remote Health 10:1372 [Google Scholar]
  48. Kazanjian A, Apland LE, Labonte R. 48.  2007. Not on the radar: the impact of rural health realities on Canadian public policy and HHR migration from Sub-Saharan Africa. Cah. Sociol. Demogr. Med. 47:4407–26 [Google Scholar]
  49. Kiarie JN, Farquhar C, Redfield R, Bosire K, Nduati RW. 49.  et al. 2014. Strengthening health systems by integrating health care, medical education, and research: University of Nairobi experience. Acad. Med. 89:8S109–10 [Google Scholar]
  50. Kilpatrick S. 50.  2009. Multi-level rural community engagement in health. Aust. J. Rural Health 17:39–44 [Google Scholar]
  51. Kolstad JR. 51.  2011. How to make rural jobs more attractive to health workers: findings from a discrete choice experiment in Tanzania. Health Econ. 20:196–211 [Google Scholar]
  52. Kruk ME, Rockers PC, Williams EH, Varpilah ST, Macauley R. 52.  et al. 2010. Availability of essential health services in post-conflict Liberia. Bull. World Health Organ. 88:527–34 [Google Scholar]
  53. Kwizera EN, Iputo JE. 53.  2011. Addressing social responsibility in medical education: the African way. Med. Teach. 33:649–53 [Google Scholar]
  54. Lambert ML, Van der Stuyft P. 54.  2002. Global health fund or global fund to fight AIDS, tuberculosis and malaria?. Trop. Med. Int. Health 7:557–58 [Google Scholar]
  55. Larkins S, Michielsen K, Iputo J, Elsanousi S, Mammen M. 55.  et al. 2015. Impact of selection strategies on representation of underserved populations and intention to practise: international findings. Med. Educ. 49:60–72 [Google Scholar]
  56. Larkins SL, Preston R, Matte MC, Lindemann IC, Samson R. 56.  et al. 2013. Measuring social accountability in health professional education: development and international pilot testing of an evaluation framework. Med. Teach. 35:32–45 [Google Scholar]
  57. Laurence CO, Williamson V, Sumner KE, Fleming J. 57.  2010. “Latte rural”: the tangible and intangible factors important in the choice of rural practice by recent GP graduates. Rural Remote Health 10:1316 [Google Scholar]
  58. Lawn JE, Rohde J, Rifkin S, Were M, Paul VK, Chopra M. 58.  2008. Alma-Ata 30 years on: revolutionary, relevant, and time to revitalize. Lancet 372:917–27 [Google Scholar]
  59. Lewin S, Lavis JN, Oxman AD, Bastías G, Chopra M. 59.  et al. 2008. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet 372:928–39 [Google Scholar]
  60. 60. LISGIS (Liberia Inst. Stat. Geo-Inf. Serv.), Minist. Health Soc. Welf., Natl. AIDS Control Program, Macro Int. Inc 2008. Liberia: Demographic and Health Survey 2007 Monrovia, Liberia: LISGIS, Macro Int. Inc http://dhsprogram.com/pubs/pdf/fr201/fr201.pdf
  61. Lori JR, Livingston L, Eagle M, Rominski S, Nakua EK, Agyei-Baffour P. 61.  2014. Rural origin and exposure drives Ghanaian midwives reported future practice. Afr. J. Reprod. Health 18:95–100 [Google Scholar]
  62. Maeseneer JD, van Weel C, Egilman D, Mfenyana K, Kaufman A, Sewankambo N. 62.  2008. Strengthening primary care: addressing the disparity between vertical and horizontal investment. Br. J. Gen. Pract. 58:1–4 [Google Scholar]
  63. Mafigiri DK, Ayebare F, Baingana RK, Okello E, Sewankambo NK. 63.  2014. Medical Education for Equitable Services for All Ugandans (MESAU) consortium: development and achievements. Acad. Med. 89:8S65–68 [Google Scholar]
  64. Mars M. 64.  2015. Telemedicine in sub-Saharan Africa: trapped in the “digital health divide”? Int. Hosp. Online, Brussels. http://www.ihe-online.com/feature-articles/telemedicine-in-sub-saharan-africa-trapped-in-the-digital-health-divide/index.html [Google Scholar]
  65. Mashego TA, Peltzer K. 65.  2005. Community perception of quality of (primary) health care services in a rural area of Limpopo province, South Africa: a qualitative study. Curationis 28:13–21 [Google Scholar]
  66. Mbarika VWA, Okoli C. 66.  2003. Telemedicine in Sub-Saharan Africa: a proposed Delphi study. Proc. 36th Annu. Hawaii Int. Conf. Syst. Sci., Big Island, HI, January 6–9, 2003. http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.3.3032 [Google Scholar]
  67. 67. McKinsey & Co 2004. Acting now to overcome Tanzania's greatest health challenge: addressing the gap in human resources for health McKinsey & Co., New York. http://www.touchfoundation.org/pdf/Acting%20now%20to%20Overcome%20Tanzania's%20Greatest%20Health%20Challenge.pdf
  68. Middleton L, Howard AA, Dohrn J, Von Zinkernagel D, Parham Hopson D. 68.  et al. 2014. The nursing education partnership initiative (NEPI): innovations in nursing and midwifery education. Acad. Med. 89:S24–28 [Google Scholar]
  69. Muula AS. 69.  2007. How do we define “rurality” in the teaching on medical geography?. Rural Remote Health 7:653 [Google Scholar]
  70. Naiker S, Plange-Rhule J, Tutt RC, Eastwood JB. 70.  2009. Shortage of healthcare workers in developing countries: Africa. Ethn. Dis. 19:Suppl. 160–64 [Google Scholar]
  71. O'Donnell O. 71.  2007. Access to health care in developing countries: breaking down demand side barriers. Cad. Saúde Pública 23:2820–34 [Google Scholar]
  72. 72. OECD (Organ. Econ. Coop. Dev.) 1994. Creating Rural Indicators for Shaping Territorial Policies Paris: OECD
  73. 73. OECD (Organ. Econ. Coop. Dev.) 2010. OECD regional typology Rep., OECD, Paris. http://www.oecd.org/gov/regional-policy/42392595.pdf
  74. Ordinioha B, Onyenaporo C. 74.  2010. Experience with the use of community health extension workers in primary care, in a private rural health care institution in South-South Nigeria. Ann. Afr. Med. 9:240–45 [Google Scholar]
  75. 75. Penfold E, Fourie P 2014. Ebola and cultures of engagement: Chinese versus Western health diplomacy Glob. Memo, Counc. Counc., Counc. Foreign Relat., New York. http://www.cfr.org/councilofcouncils/global_memos/p33560
  76. Reid SJ. 76.  2006. Rural health and transformation in South Africa. S. Afr. Med. J. 96:676–77 [Google Scholar]
  77. Richter R. 77.  2014. Health-care aid for developing countries boosts life expectancy. Stanford Med., Stanford Univ. http://med.stanford.edu/news/all-news/2014/04/health-care-aid-for-developing-countries-boosts-life-expectancy-study-finds.html
  78. Ross SJ, Preston R, Lindemann IC, Matte MC, Samson R. 78.  et al. 2014. The training for health equity network evaluation framework: a pilot study at five health professional schools. Educ. Health 27:116–26 [Google Scholar]
  79. Scheil-Adlung X. 79.  2015. Global evidence on inequities in rural health protection: new data on rural deficits in health coverage for 174 countries. ESS Doc. 47, Int. Labour Organ., Geneva. http://www.social-protection.org/gimi/gess/RessourcePDF.action?ressource.ressourceId=51297
  80. Somers GT, Strasser R, Jolly B. 80.  2007. What does it take? The influence of rural upbringing and sense of rural background on medical students' intention to work in a rural environment. Rural Remote Health 7:706 [Google Scholar]
  81. Soucat A, Scheffler R. 81.  2013. Labour market analysis of human resources for health. The Labor Market for Health Workers in Africa: A New Look at the Crisis A Soucat, R Scheffler, T Adhanom Ghebreyesus 1–12 Washington, DC: World Bank [Google Scholar]
  82. Stagg P, Greenhill J, Worley PS. 82.  2009. A new model to understand the career choice and practice location decisions of medical graduates. Rural Remote Health 9:1245 [Google Scholar]
  83. Stange KC, Etz RS, Gullett H, Sweeney SA, Miller WL. 83.  et al. 2014. Metrics for assessing improvements in primary health care. Annu. Rev. Public Health 35:423–42 [Google Scholar]
  84. Starfield B. 84.  2009. Primary care and equity in health: the importance to effectiveness and equity of responsiveness to people's needs. Humanit. Soc. 33:56–73 [Google Scholar]
  85. Starfield B. 85.  2009. The contribution of primary care to equity: How and what do we do now? Keynote Address, 9th WONCA Rural Health Conf., Heraklion, Greece, June 12
  86. Starfield B, Shi L, Grover A, Macinko J. 86.  2005. The effects of specialist supply on populations' health: assessing the evidence. Health Aff. (Millwood). Suppl. Web Exclus. March:W5-97–107 [Google Scholar]
  87. Starfield B, Shi L, Macinko J. 87.  2005. Contribution of primary care to health systems and health. Milbank Q. 83:457–502 [Google Scholar]
  88. Strasser R. 88.  2003. Rural health around the world: challenges and solutions. Fam. Pract. 20:457–63 [Google Scholar]
  89. Strasser R, Hogenbirk JC, Lewenberg M, Story M, Kevat A. 89.  2010. Starting rural, staying rural: How can we strengthen the pathway from rural upbringing to rural practice?. Aust. J. Rural Health 18:242–48 [Google Scholar]
  90. Strasser R, Worley P, Cristobal F, Marsh DC, Berry S. 90.  et al. 2015. Putting communities in the driver's seat: the realities of community-engaged medical education. Acad. Med. 90:111466–70 [Google Scholar]
  91. Tulenko K, Gasakure E, Neusy A. 91.  2013. Health worker education and training. The Labor Market for Health Workers in Africa: A New Look at the Crisis A Soucat, R Scheffler, T Adhanom Ghebreyesus 301–18 Washington, DC: World Bank [Google Scholar]
  92. 92. UN Gen. Assem 2013. Outcome document of the special event to follow up efforts made towards achieving the millennium development goals. Draft Resolut., 68th Sess. A/68/L.4
  93. Unger JP, Paepe P, Green A. 93.  2003. A code of best practice for disease control programmes to avoid damaging health care services in developing countries. Int. J. Health Plan. Manag. 18:S27–39 [Google Scholar]
  94. 94. WHO (World Health Organ.) 2008. The World Health Report 2008. Primary Health Care: Now More Than Ever Geneva: WHO http://www.who.int/whr/2008/whr08_en.pdf
  95. 95. WHO (World Health Organ.) 2010. Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention: Global Policy Recommendations Geneva: WHO http://www.searo.who.int/nepal/mediacentre/2010_increasing_access_to_health_workers_in_remote_and_rural_areas.pdf
  96. 96. WHO (World Health Organ.) 2015. Health systems: health workforce WHO, Geneva. http://www.who.int/healthsystems/topics/workforce/en/
  97. Wibulpolprasert S. 97.  2015. How do we produce and maintain rural generalists in Thailand. Presented at World Summit Rural Gen. Med., 2nd, April 8–9, Montreal, Canada
  98. Willmer G. 98.  2015. Diagnostic tests plumb depths of “hidden malaria.” SciDev.Net, April 1. http://www.scidev.net/global/malaria/news/malaria-diagnostic-tests.html
  99. Wilson NW, Couper ID, De Vries E, Reid S, Fish T, Marais BJ. 99.  2009. A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health 9:1060 [Google Scholar]
  100. 100. World Bank 2015. Sub-Saharan Africa (developing only) World Bank, Washington, DC. http://data.worldbank.org/region/SSA [Google Scholar]
  101. Wyss K. 101.  2004. An approach to classifying human resources constraints to attaining health-related millennium development goals. Hum. Resour. Health 2:11 [Google Scholar]
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