INTERNATIONAL EXPERIENCE IN PUBLIC ADMINISTRATION OF HEALTH WORKFORCE SUSTAINABILITY IN RURAL AND REMOTE AREAS
DOI:
https://doi.org/10.35433/ISSN2410-3748-2026-1(38)-20Keywords:
healthcare workforce retention, rural and remote areas, public administration of healthcare, health workforce policy, retention instruments, multilevel governance, workforce shortageAbstract
The article systematizes international experience in retaining healthcare workers in rural and remote areas within the context of contemporary challenges to the workforce sustainability of health systems. The purpose of the study is to summarize international approaches to addressing workforce attrition through the analysis of three interrelated dimensions: the factors that cause unstable retention of healthcare professionals; the instruments used to improve their retention; and the governance mechanisms through which these instruments are implemented at different levels of public administration. The study demonstrates that workforce instability in peripheral territories is multifactorial and is shaped by professional overload, poor working environments, professional isolation, limited career and professional development opportunities, unfavorable living conditions, and difficulties of social integration. On this basis, the paper identifies the main groups of retention instruments, including educational, financial, regulatory, professional support, organizational and labor-related, social and living-condition, community-oriented, and strategic workforce planning instruments. It is argued that none of these instruments can ensure sustainable results in isolation; their effectiveness depends on coherence, consistency of implementation, and adaptation to the specific characteristics of a given territory. The article shows that the most effective models are multilevel, partnership-based, and context-sensitive, in which the central government establishes the regulatory and financial framework, the regional level coordinates and adapts the instruments, and the local level creates the actual conditions for the professional and social embedding of healthcare workers. It is concluded that, for Ukraine, the practical value of this experience lies in the need to move from fragmented personnel decisions to a long-term, intersectorally coordinated retention policy aimed at strengthening the workforce sustainability of rural healthcare under conditions of demographic ageing, territorial disparities, and post-war health system recovery.
References
Marchand, C., & Peckham, S. (2017). Addressing the crisis of GP recruitment and retention: A systematic review. British Journal of General Practice, 67(657), e227–e237. https://doi.org/10.3399/bjgp17X689929
European Public Health Association. (2025). PechaKucha: Health and care workforce retention: How to integrate the needs of rural and remote areas? European Journal of Public Health, 35(Supplement 4), iv284. https://academic.oup.com/eurpub/article/35/Supplement_4/ckaf161.699/8301359
Mbemba, G. I. C., Gagnon, M.-P., & Hamelin-Brabant, L. (2016). Factors influencing recruitment and retention of healthcare workers in rural and remote areas in developed and developing countries: An overview. Journal of Public Health in Africa, 7, 565. https://doi.org/10.4081/jphia.2016.565
Osorio, R., Morais, R., & Correia, T. (2026). Physician retention in a context of workforce shortages: Evidence from Portugal’s National Health Service with European policy implications. European Journal of Public Health, 36(Supplement 1), i28–i33. https://doi.org/10.1093/eurpub/ckaf239
Abelsen, B., Strasser, R., Heaney, D., Berggren, P., Sigurðsson, S., Brandstorp, H., Wakegijig, J., Forsling, N., Moody-Corbett, P., Healey Akearok, G., Mason, A., Savage, C., & Nicoll, P. (2020). Plan, recruit, retain: A framework for local healthcare organizations to achieve a stable remote rural workforce. Human Resources for Health, 18, 63. https://doi.org/10.1186/s12960-020-00502-x
World Health Organization. (2021). WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. https://www.who.int/publications/i/item/9789240024229
Russell, D., Mathew, S., Fitts, M., Liddle, Z., Murakami-Gold, L., Campbell, N., Ramjan, M., Zhao, Y., Hines, S., Humphreys, J. S., & Wakerman, J. (2021). Interventions for health workforce retention in rural and remote areas: A systematic review. Human Resources for Health, 19, 103. https://doi.org/10.1186/s12960-021-00643-7
Lehmann, U., Dieleman, M., & Martineau, T. (2008). Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention. BMC Health Services Research, 8, 19. https://doi.org/10.1186/1472-6963-8-19
Gillespie, J., Cosgrave, C., & Malatzky, C. (2022). Making the case for place based governance in rural health workforce recruitment and retention: Lessons from Canada and Australia. Social Sciences & Humanities Open, 6, 100356. https://doi.org/10.1016/j.ssaho.2022.100356
McGrail, M. R., O’Sullivan, B. G., & Russell, D. J. (2018). Rural training pathways: The return rate of doctors to work in the same region as their basic medical training. Human Resources for Health, 16, 56. https://doi.org/10.1186/s12960-018-0323-7
Noya, F., Carr, S., Thompson, S., Clifford, R., & Playford, D. (2021). Factors associated with the rural and remote practice of medical workforce in Maluku Islands of Indonesia: A cross-sectional study. Human Resources for Health, 19, 126. https://doi.org/10.1186/s12960-021-00667-z
Willis-Shattuck, M., Bidwell, P., Thomas, S., Wyness, L., Blaauw, D., & Ditlopo, P. (2008). Motivation and retention of health workers in developing countries: A systematic review. BMC Health Services Research, 8, 247. https://doi.org/10.1186/1472-6963-8-247
Grobler, L., Marais, B. J., & Mabunda, S. (2015). Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database of Systematic Reviews, (6), CD005314. https://doi.org/10.1002/14651858.CD005314.pub3
Tort-Nasarre, G., Vidal-Alaball, J., Fígols Pedrosa, M. J., Vazquez Abanades, L., Forcada Arcarons, A., & Deniel Rosanas, J. (2023). Factors associated with the attraction and retention of family and community medicine and nursing residents in rural settings: A qualitative study. BMC Medical Education, 23, 662. https://doi.org/10.1186/s12909-023-04650-1
Kumar, S., & Clancy, B. (2021). Retention of physicians and surgeons in rural areas—what works? Journal of Public Health, 43(4), e689–e700. https://doi.org/10.1093/pubmed/fdaa031
Bland, A., Meyer, A., Orrantia, E., Hale, I., & Grzybowski, S. (2024). Rural physician–community engagement: Building, supporting and maintaining resilient health care strategies in three rural Canadian communities. Australian Journal of Rural Health, 32, 930–937. https://doi.org/10.1111/ajr.13154
World Health Organization. (2016). Global strategy on human resources for health: Workforce 2030. https://www.who.int/publications/i/item/9789241511131
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Автори, які публікуються у цьому журналі, погоджуються з наступними умовами:
a) Автори залишають за собою право на авторство своєї роботи та передають журналу право першої публікації цієї роботи на умовах ліцензії Creative Commons Attribution License, котра дозволяє іншим особам вільно розповсюджувати опубліковану роботу з обов'язковим посиланням на авторів оригінальної роботи та першу публікацію роботи у цьому журналі.
b) Автори мають право укладати самостійні додаткові угоди щодо неексклюзивного розповсюдження роботи у тому вигляді, в якому вона була опублікована цим журналом (наприклад, розміщувати роботу в електронному сховищі установи або публікувати у складі монографії), за умови збереження посилання на першу публікацію роботи у цьому журналі.
c) Політика журналу дозволяє і заохочує розміщення авторами в мережі Інтернет (наприклад, у сховищах установ або на особистих веб-сайтах) рукопису роботи, як до подання цього рукопису до редакції, так і під час його редакційного опрацювання, оскільки це сприяє виникненню продуктивної наукової дискусії та позитивно позначається на оперативності та динаміці цитування опублікованої роботи (див. The Effect of Open Access).
