Policy-makers in every country are faced with the significant challenge of meeting the health needs of their populations, including those vulnerable communities in remote and rural areas. In order to ensure the equitable delivery of health services in these areas, skilled and motivated health workers need to be in the right place at the right time.
Following various international calls for action from global leaders, civil society and Member States, in February 2009 the WHO launched a programme to increase access to health workers in remote and rural areas through improved retention. This programme was developed in order to support countries to address the critical issues of retention and equitable distribution of health workers.
The programme consists of three strategic pillars:
Building and sharing the evidence base
Supporting countries in the analysis, evaluation and implementation of effective strategies
Producing and disseminating policy recommendations and guidelines.
Substantial work has gone into expanding the evidence base on retention strategies and developing the global recommendations. At the launch of the programme, the expert group convened by WHO to develop evidence-based recommendations in this field identified the key evidence gaps in this domain. Subsequently, additional systematic reviews of the evidence have been commissioned by WHO to fill these gaps. In addition, a series of country case studies have also been commissioned, following a common template developed by the expert group, to better understand the importance of context and the way different countries have approached the issue of rural retention of health workers.
This report presents an overview of outreach services provided by health workers to remote and rural populations in different countries and contexts. It aims to highlight the potential for these alternative health service delivery models, such as mobile clinics and telemedicine, to enhance the attraction and retention of health workers in underserved areas and encourages further evaluations to be conducted in this area.
The authors stipulate that not only can the various different forms of outreach services improve access to health care, but they can be key in decreasing the sense of isolation felt by those health workers who are posted in hard to reach areas and provide key professional support. Indeed, outreach services can be a valuable addition in the “bundling” of retention strategies and should be explored further as part of innovative approaches to attract and retain health workers in remote and rural areas.
