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Bull World Health Organ. 2013 Nov 1;91(11):834-40. doi: 10.2471/BLT.13.119008.

Early implementation of WHO recommendations for the retention of health workers in remote and rural areas.

Author information

  • 1Queen Margaret University, Edinburgh, Scotland .
  • 2Centre for Rural Health, University of Witwatersrand, Johannesburg, South Africa .
  • 3International Health Policy Programme, Ministry of Health, Bangkok, Thailand .
  • 4Department of Health Personnel, Ministry of Health, Vientiane, Lao People's Democratic Republic.
  • 5IntraHealth International, Chapel Hill, North Carolina, United States of America .
  • 6Europe Regional Office, World Health Organization, Copenhagen, Denmark .
  • 7Health Systems Policies and Workforce, World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland .


in English, Arabic, Chinese, French, Russian, Spanish

The maldistribution of health workers between urban and rural areas is a policy concern in virtually all countries. It prevents equitable access to health services, can contribute to increased health-care costs and underutilization of health professional skills in urban areas, and is a barrier to universal health coverage. To address this long-standing concern, the World Health Organization (WHO) has issued global recommendations to improve the rural recruitment and retention of the health workforce. This paper presents experiences with local and regional adaptation and adoption of WHO recommendations. It highlights challenges and lessons learnt in implementation in two countries - the Lao People's Democratic Republic and South Africa - and provides a broader perspective in two regions - Asia and Europe. At country level, the use of the recommendations facilitated a more structured and focused policy dialogue, which resulted in the development and adoption of more relevant and evidence-based policies. At regional level, the recommendations sparked a more sustained effort for cross-country policy assessment and joint learning. There is a need for impact assessment and evaluation that focus on the links between the rural availability of health workers and universal health coverage. The effects of any health-financing reforms on incentive structures for health workers will also have to be assessed if the central role of more equitably distributed health workers in achieving universal health coverage is to be supported.

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