In almost all countries around the world, there are fewer health care professionals working in rural and urban underserved areas. In urban areas in Australia, there is one doctor for every 970 people, but in rural areas there is one for every 1328 people. In the United States of America, only 9% of physicians practice in rural areas where 20% of the population live. In low- and middle-income countries the shortage is even greater. This shortage makes it particularly difficult for people in underserved areas to access health services and be healthy. While some health care professionals choose to work in underserved areas, they are a small minority and strategies are needed to persuade more to do so. A variety of strategies have been adopted including educational, financial, regulatory and supportive strategies. For example, some medical schools try to recruit more people from rural areas in the hope that they will return to those areas to practice. Scholarships, grants, loan repayment schemes, and higher salaries are offered to professionals working in underserved areas. A number of countries have made it mandatory for health care professionals to work for a period of time in underserved areas. While some of these strategies have shown promise, this review found no well-designed studies to say whether any of these strategies are effective or not. Rigorous studies are needed to evaluate the true effect of these strategies to increase the number of health care professionals working in underserved areas.
This research is supported by the Department for International Development’s Evidence Building and Synthesis Research Programme which is led by Liverpool School of Tropical Medicine
Grobler, L.; Marais, B.J.; Mabunda, S.A.; Marindi, P.N.; Reuter, H.; Volmink, J. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database of Systematic Reviews (2015) [DOI/10.1002/14651858.CD005314.pub3]
Interventions for increasing the proportion of health professionals practising in rural and other underserved areas