Lao People’s Democratic Republic

In Lao People’s Democratic Republic (PDR), health workers are concentrated in cities while approximately 70% of the population lives in rural areas. As in many countries, attracting health workers to rural posts—and retaining them—is a challenge. CapacityPlus helped the Ministry of Health to strengthen health workforce recruitment and retention, thereby increasing access to high-quality family planning/reproductive health and other services.

Highlights

• To determine what would motivate health workers to serve and stay in rural areas, the Ministry of Health, in partnership with CapacityPlus and the World Health Organization (WHO), conducted a rapid discrete choice experiment using CapacityPlus’s Rapid Retention Survey Toolkit. The ministry surveyed 970 health professional students and 483 health workers practicing in rural provinces to investigate their preferences for potential packages of incentives to increase recruitment and retention in the country’s rural and remote settings. Next the ministry gauged the financial feasibility of the preferred incentive packages using iHRIS Retain, the costing tool developed by CapacityPlus in collaboration with the WHO.

• The survey results and costing data informed a new national recruitment and retention policy for the health workforce. The policy stipulates that all new graduates in medicine, nursing, midwifery, pharmacy, and dentistry, as well as postgraduates in family medicine, must complete three years of compulsory rural service in order to receive their licenses. The policy includes specific incentives to motivate health workers to provide high-quality services as well as encourage them to stay after the compulsory service has ended.

• The first phase of the policy, initiated in 2013, placed 360 newly qualified doctors, pharmacists, and dentists in 51 rural districts (of 142 total districts). The second phase, implemented in 2014, placed an additional 1,191 health workers across the country to provide essential health services. As a result of the increased recruitment and deployment of health workers in rural areas, CapacityPlus estimates that over two million additional clients will gain access to a health worker.

• CapacityPlus assisted the ministry to conduct a review of the new policy in four districts in Bolikhamxay Province. In Vienthong District, for example, hospital managers reported that the number of patients increased by 50% after newly-graduated health workers arrived.

• Building on this work, CapacityPlus supported the ministry to field-test the Health Workforce Productivity Analysis and Improvement Toolkit in 12 health centers and three district hospitals in Bolikhamxay Province, in collaboration with the WHO.

• A peer-reviewed article, Net Costs of Health Workers Rural Incentive Packages: An Example from the Lao People’s Democratic Republic, revealed that when the population health benefits of rurally deployed health workers are taken into account, the expected net cost of rural incentive programs is substantially less than the original estimate of direct costs, and supports the use of discrete choice experiment surveys, costing surveys, and cost-benefit analysis methods to inform potential health worker retention programs or policies.

Photo by Wanda Jaskiewicz