Overview

With nearly half of the world’s population living in a rural or remote area, meeting the health needs of rural populations, where over 80% of the world’s extremely poor live, is imperative in achieving universal health coverage. Leaving no one behind means ensuring that health workers are available in rural and remote areas.

Health, social and economic inequities remain cross-cutting challenges for rural populations. Rural populations tend to be poorer, have worse health outcomes, and experience higher rates of unemployment, underemployment and informal employment. It is estimated that about 51–67% of rural populations are without adequate access to essential health services , translating to about 2 billion people being left behind. In some countries, rural populations have access to numbers of health workers that are 10 times less than the numbers available to urban populations.

The deficiency in numbers and mix of trained motivated health workers to provide the needed health services is a critical health system issue. This inequitable access to health workers and health services impacts health outcomes and increases socioeconomic disadvantages. Higher under-5, maternal and preventable mortality rates, increased morbidity, decreased life expectancy, and more costs to access distant care are seen across rural areas.

Contents

• Acknowledgements
• Glossary of terms
• Executive summary
• 1.0. Background
  • 1.1. Rationale
  • 1.2. Previous recommendations on increasing access to health workers in rural and remote areas
  • 1.3. Target audience
  • 1.4. Objectives of this guideline
• 2.0. Methods
  • 2.1. Scope
  • 2.2. Process for reviewing this guideline and methodology
  • 2.3. Results
  • 2.4. Formulation of the recommendations
  • 2.5. Formulation of a good practice statement for guidelines
  • 2.6. Guiding principles for the formulation of policies to improve access to health workers in rural and remote areas
• 3.0. Good practice statement and recommendations
  • Good practice statement for the development, attraction, recruitment and retention of health workers in rural and remote areas
  • 3.1. Recommendation 1: Enrol students with a rural background in health worker education programmes
  • 3.2. Recommendation 2: Locate health worker education facilities closer to rural areas
  • 3.3. Recommendation 3: Bring students in health worker education programmes to rural and remote communities
  • 3.4. Recommendation 4: Align health worker education with rural health needs
  • 3.5. Recommendation 5: Facilitate continuing education for rural and remote health workers
  • 3.6. Recommendation 6: Enable rural health workers to enhance their scopes of practice to better meet the needs of their communities
  • 3.7. Recommendation 7: Expand range of health worker occupations to meet rural health needs
  • 3.8. Recommendation 8: Ensure that compulsory service agreements respect the rights of health workers and are accompanied with appropriate support and incentives
  • 3.9. Recommendation 9: Tie education subsidies for health workers to agreements for return of service in rural areas and remote areas
  • 3.10. Recommendation 10: Provide a package of attractive incentives to influence health workers’ decisions to relocate to or remain in a remote or rural area
  • 3.11. Recommendation 11: Improve living conditions in rural and remote areas
  • 3.12. Recommendation 12: Ensure workplace safety in rural and remote health facilities
  • 3.13. Recommendation 13: Ensure decent work for health workers in rural and remote areas
  • 3.14. Recommendation 14: Foster the creation of health workforce support networks
  • 3.15. Recommendation 15: Develop and strengthen career pathways for rural health workers
  • 3.16. Recommendation 16: Facilitate knowledge exchange between health workers
  • 3.17. Recommendation 17: Raise the profile of rural health workers
• 4.0. Selecting and evaluating the bundle of interventions
  • 4.1. Relevance: which interventions best respond to national priorities, and to the expectations of health workers and rural communities?
  • 4.2. Acceptability: which interventions are politically and socioculturally acceptable and have the most stakeholder support?
  • 4.3. Feasibility: which interventions face the fewest barriers to implementation?
  • 4.4. Affordability: which interventions are cost effective and what is their fiscal impact?
  • 4.5. Effectiveness: have complementarities and potential unintended consequences between various interventions been considered?
  • 4.6. Impact: what indicators will be used to measure impact over time?
  • 4.7. Dissemination and implementation plans for this guideline
• 5.0. Research agenda
  • 5.1. Expanding the evidence base
  • 5.2. Mainstreaming rural access into health systems and health outcomes research
  • 5.3. Ensuring evaluations are rigorous and well designed
• 6.0. Updating this guideline
• References
• Web Annexes
  • Web Annex A. WHO guidelines and tools that support the guideline
  • Web Annex B. Questions in population, intervention, comparison, outcome of interest, and setting (PICOS) format
  • Web Annex C. Members of Steering Group, Guideline Development Group and External Review Group, and conflict of interest management
  • Web Annex D. Authors of the updated systematic review (2010–2019)
  • Web Annex E. Checklist of criteria to be met before making a good practice recommendation, developed by the GRADE Working Group
  • Web Annex F. Evolution of the recommendation
  • Web Annex G. Summaries of evidence
  • Web Annex H. Summaries of evidence to decision tables

Suggested citation:

WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

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An update of the WHO guideline Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations (2010)