Retaining doctors in rural Bangladesh: A policy analysis
This article was published in the International Journal of Health Policy and Management [© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licens...
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International Journal of Health Policy and Management
2022
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10361-16420 |
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10361-164202022-03-08T21:01:28Z Retaining doctors in rural Bangladesh: A policy analysis Joarder, Taufique Rawal, Lal B. Ahmed, Syed Masud Uddin, Aftab Evans, Timothy G. Brac James P. Grant School of Public Health Health Systems Research Human Resources for Health Rural Retention Policy Analysis Bangladesh This article was published in the International Journal of Health Policy and Management [© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) ] and the definite version is available at: https://doi:10.15171/ijhpm.2018.37 The Journal's website is at: https://www.ijhpm.com/?_action=articleInfo&article=3495&lang Background Retaining doctors in rural areas is a challenge in Bangladesh. In this study, we analyzed three rural retention policies: career development programs, compulsory services, and schools outside major cities – in terms of context, contents, actors, and processes. Methods Series of group discussions between policy-makers and researchers prompted the selection of policy areas, which were analyzed using the policy triangle framework. We conducted document and literature reviews (1971-2013), key informant interviews (KIIs) with relevant policy elites (n = 11), and stakeholder analysis/position-mapping. Results In policy-1, we found, applicants with relevant expertise were not leveraged in recruitment, promotions were often late and contingent on post-graduation. Career tracks were porous and unplanned: people without necessary expertise or experience were deployed to high positions by lateral migration from unrelated career tracks or ministries, as opposed to vertical promotion. Promotions were often politically motivated. In policy-2, females were not ensured to stay with their spouse in rural areas, health bureaucrats working at district and sub-district levels relaxed their monitoring for personal gain or political pressure. Impractical rural posts were allegedly created to graft money from applicants in exchange for recruitment assurance. Compulsory service was often waived for political affiliates. In policy-3, we found an absence of clear policy documents obligating establishment of medical colleges in rural areas. These were established based on political consideration (public sector) or profit motives (private sector). Conclusion Four cross-cutting themes were identified: lack of proper systems or policies, vested interest or corruption, undue political influence, and imbalanced power and position of some stakeholders. Based on findings, we recommend, in policy-1, applicants with relevant expertise to be recruited; recruitment should be quick, customized, and transparent; career tracks (General Health Service, Medical Teaching, Health Administration) must be clearly defined, distinct, and respected. In policy-2, facilities must be ensured prior to postings, female doctors should be prioritized to stay with the spouse, field bureaucrats should receive non-practising allowance in exchange of strict monitoring, and no political interference in compulsory service is assured. In policy-3, specific policy guidelines should be developed to establish rural medical colleges. Political commitment is a key to rural retention of doctors. Published 2022-03-08T06:28:43Z 2022-03-08T06:28:43Z 2018 2018-09 Journal Article Joarder, T., Rawal, L. B., Ahmed, S. M., Uddin, A., & Evans, T. G. (2018). Retaining doctors in rural bangladesh: A policy analysis. International Journal of Health Policy and Management, 7(9), 847-858. doi:10.15171/ijhpm.2018.37 http://hdl.handle.net/10361/16420 10.15171/IJHPM.2018.37 en_US https://www.ijhpm.com/?_action=articleInfo&article=3495&lang application/pdf International Journal of Health Policy and Management |
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Brac University |
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Institutional Repository |
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en_US |
| topic |
Health Systems Research Human Resources for Health Rural Retention Policy Analysis Bangladesh |
| spellingShingle |
Health Systems Research Human Resources for Health Rural Retention Policy Analysis Bangladesh Joarder, Taufique Rawal, Lal B. Ahmed, Syed Masud Uddin, Aftab Evans, Timothy G. Retaining doctors in rural Bangladesh: A policy analysis |
| description |
This article was published in the International Journal of Health Policy and Management [© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) ] and the definite version is available at: https://doi:10.15171/ijhpm.2018.37 The Journal's website is at: https://www.ijhpm.com/?_action=articleInfo&article=3495&lang |
| author2 |
Brac James P. Grant School of Public Health |
| author_facet |
Brac James P. Grant School of Public Health Joarder, Taufique Rawal, Lal B. Ahmed, Syed Masud Uddin, Aftab Evans, Timothy G. |
| format |
Journal Article |
| author |
Joarder, Taufique Rawal, Lal B. Ahmed, Syed Masud Uddin, Aftab Evans, Timothy G. |
| author_sort |
Joarder, Taufique |
| title |
Retaining doctors in rural Bangladesh: A policy analysis |
| title_short |
Retaining doctors in rural Bangladesh: A policy analysis |
| title_full |
Retaining doctors in rural Bangladesh: A policy analysis |
| title_fullStr |
Retaining doctors in rural Bangladesh: A policy analysis |
| title_full_unstemmed |
Retaining doctors in rural Bangladesh: A policy analysis |
| title_sort |
retaining doctors in rural bangladesh: a policy analysis |
| publisher |
International Journal of Health Policy and Management |
| publishDate |
2022 |
| url |
http://hdl.handle.net/10361/16420 |
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