A staff support programme for rural hospitals in Nepal

Area of Science:

• Global Health
• Health Services Research
• Human Resources for Health

Background:

• District hospitals in Nepal face challenges in providing essential services, including caesarean sections.
• Health worker retention is crucial for sustained, quality healthcare in rural areas.
• Nepal's geography, poverty, and uneven health worker distribution create significant healthcare access barriers.

Purpose of the Study:

• To assess the impact of a rural staff support program on health worker retention and service delivery in remote Nepalese hospitals.
• To evaluate the effectiveness of a comprehensive human resource support package in improving healthcare access in underserved regions.

Main Methods:

• The Government of Nepal and the Nick Simons Institute implemented a program providing family practice doctors with surgical and obstetrical skills to rural hospitals.
• Doctors were recruited via a compulsory-service scholarship and served on a three-year contract.
• Support included housing, internet, in-service training, and hospital management capacity development.

Main Results:

• Family practice doctors were retained in all seven program hospitals from 2011 to 2015.
• All participating hospitals became capable of providing comprehensive emergency obstetric care.
• Deliveries increased by 203% in program hospitals compared to 71% in non-program hospitals (P=0.002).

Conclusions:

• A multifaceted human resource support strategy can successfully improve doctor retention in remote hospitals.
• Key success factors included compulsory-service scholarships, centralized personnel management, performance incentives, and adequate living conditions.
• The program's success led to its expansion to 14 hospitals, indicating its scalability and effectiveness.