Romania's 2025 guide for health workforce attraction and retention: Bridging global strategies and local realities

Romania's health system faces a challenge of health workforce maldistribution, especially in rural and non-university urban areas. A national policy reform was launched in 2024-2025, supported by the National Recovery and Resilience Plan and WHO technical assistance. The reform's objective was to equip and empower local authorities to improve the recruitment, retention, and motivation of health professionals in their communities.

The reform involves the development and nationwide dissemination of the "Solutions for Human Resources in Health: Guide of Local Actions". Developed through a participatory, evidence-based process with stakeholders, this guide is a practical toolkit for local authorities and hospital managers. It consolidates underused legal frameworks and curates national and international best practices examples across four main pillars: Education, Incentives, Regulation, and Support.

The primary expected outcome is an improvement in the geographical distribution of the health workforce, resulting in better-staffed facilities in underserved regions. A key secondary outcome is the boost in local authorities' administrative capacity and proactive involvement in the health workforce management, which fosters greater ownership and a more sustainable, decentralized approach to addressing staffing challenges. These outcomes will become measurable over the medium-to-long term as local authorities implement the guide's provisions.

The collaborative, evidence-based process used for the guide exemplifies a best practice model for stakeholder-driven policy development. The Romanian experience provides a transferable framework for countries with decentralized health systems to empower local actors in addressing health workforce maldistribution, though long-term success depends on local implementation and political will.