Staffing remote rural areas with health workers is one of the main challenges facing middle and low income countries looking to achieve the Millennium Development Goals including reducing the maternal death rate. Sudan is an African low income country faced with a shortage of health workers. This shortage is coupled with a misdistribution of health workers. Most of the doctors and specialists prefer to work in the capital Khartoum. However, in the last few years, Sudan has succeeded in reducing maternal death. This research aimed to undertake a realistic evaluation of the key strategies adopted by the Sudanese government to staff remote underserved areas by health workers. A literature review followed by documentary analysis aided the construction of two separate but interconnected attraction and retention frameworks and the development of the context- mechanism- outcome-configurations (CMOCs) related to staffing remote rural areas with maternal health workers. Next, qualitative semi-structured interviews were conducted in order to test these CMOCs. The interviewees included policy makers, executive health managers and health workers, both those currently working in rural areas and those who had done so in the past. The findings are presented with respect to identified CMOCs and the proposed attraction and retention frameworks. The findings have been presented in the form of what works, what does not, how, for whom and under what circumstances. The findings were analysed and discussed with respect to the relevant literature to facilitate development of recommendations which need to be considered to achieve better staffing of rural health facilities. This research has explained the past and current initiatives adopted by the Sudanese government to staff underserved areas with maternal health workers. It also showed how the “context” affected the success or failure of these strategies. This research is useful for other low income countries that suffer from inequitable distribution of its health workforce. The research has contributed to new understanding by developing separate attraction and retention frameworks for doctors and midwives. In addition to that effective interventions which are found in Sudan but not previously found in the literature have been identified and summarised.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:626928 |
| Date | January 2014 |
| Creators | Ali, Tarig Ali Suliman |
| Publisher | University of Manchester |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | https://www.research.manchester.ac.uk/portal/en/theses/identifying-and-responding-to-the-challenge-of-staffing-remote-rural-areas-with-health-workers-in-middle-and-low-income-countries-the-case-of-sudan(9df52fba-0504-475f-945a-99529fcb7e29).html |
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