Rural/Urban Imbalance

This paper reviews available research evidence that links medical students’ characteristics with human resource imbalances and the contribution of medical schools in perpetuating an inequitable distribution of the health workforce. [from abstract]

This article posits that out-migration of health workers is not a critical contributor to health workforce shortages in Nigeria’s rural and remote areas and that more important factors include: contraction of government health spending as a percentage of GDP despite deteriorating health conditions, public health management systems that operate by default rather than by design, spartan living conditions outside urban areas, inadequate training of appropriate cadres of health staff, limited facilities and medications for effective delivery of clinical services, and burnout of overworked and unde

This study examines US osteopathic residents’ and medical students’ attitudes and willingness to practice in rural medicine. The multiple aims of this study were to determine: if there are any significant differences in interest in rural medicine among various levels of training; the relative age, gender, and race of those who are intending to pursue a career in rural health; and whether a number of demographic characteristics or participation in a rural elective significantly impacted interest in practicing in a rural area. [adapted from abstract]

The maldistribution of physicians between urban and rural areas has long been an important political issue in Japan. The aim of this study was to evaluate long-term transition in the geographic distribution of physicians, and to reveal which rural physician characteristics predict their retention in rural areas. [adapted from abstract]

Rural and remote areas of Australia are facing serious health workforce shortages. While a
number of schemes have been developed to improve recruitment to and retention of the rural
health workforce, they will be effective only if appropriately targeted. This study examines
the factors that most encourage students attending rural clinical placements to work in rural
Australia, and the regions they prefer. [from abstract]

The proportion of international medical graduates (IMGs) serving as primary care physicians in rural underserved areas (RUAs) has important policy implications. We analyzed the 2000 American Medical Association Masterfile and Area Resource File to calculate the percentage of primary care IMGs, relative to U.S. medical graduates, working in RUAs. [from abstract]

The purpose of this article was to analyze and compare the graduates of an urban- and a rural-located university in Democratic Republic of the Congo (DRC) where there is major maldistribution of physicians. While 70% of Congolese live in rural areas, relatively few doctors practice there. The results of the research for this article support the policy of establishing medical schools in rural areas, and also provide indications of approaches likely to increase the number and expertise of rural-located physicians. [adapted from abstract]

This article describes the impact of community service doctors on offsetting the shortage of health professionals in public hospitals in South Africa. [adapted from introduction]

This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors to rural and remote areas of Australia. [adapted from abstract]

This article assesses the potential impact of financial incentives in alleviating health worker shortages in underserved areas through contracting future health workers to work for a number of years in an underserved area in exchange for a financial pay-off. [adapted from author]

Increasing the proportion of rural-origin students in health sciences faculties has been shown to be one way of addressing of health care professionals in rural areas. This article discusses a retrospective descriptive study to determine the proportion of rural-origin students
at all medical schools in South Africa. [adapted from abstract]

There is a serious shortage of health professionals in rural and remote areas in Australia and world wide. The purpose of this article was to add to existing information about allied health students, particularly occupational therapy students, and rural and remote practice by reviewing the literature on occupational therapy students’ perceptions of rural and remote practice. A variety of influencing factors were identified, as were the main characteristics of rural practice in relation to the future employment of students. [abstract]

Regional Australia is critically short of registered nurses (RNs) due to an ageing nursing workforce and difficulty in attracting new staff. It is recognised that rural background is the most influential factor shaping a health professional’s decision to practise in regional areas. Because of this, Charles Sturt University offered a bachelor of nursing by distance education (DE), enabling rural and remote enrolled nurses (ENs)to upgrade their qualifications to RN. However, despite the flexible study mode offered, many rural and remote ENs were reluctant to progress to university study.

The Rural Allied Health Workforce Study (RAHWS) uses a cross-sectional survey instrument with high validity to provide a large scale but detailed profile of the allied health workforce in regional, rural and remote Australia. The RAHWS survey instrument has been designed to provide uniform data across a wide range of healthcare settings and will be used to explore the rural allied health workforce in rural regions in Australia during 2009 and 2010. [from abstract]

This video resource details the social, economic and health care services disparities between urban and rural areas of Tajikistan and how women there struggle with their health and the role of men, or the lack thereof, in supporting them. [adapted from synopsis]

This article reports on research that assessed international and national best practice in the selection of students for graduate entry medical courses in order to investigate correlations between medical student selection procedures and exposure to rural medical practice during medical training with choice of careers in rural medicine. Central to the study was the issue of the medical workforce shortage in Australia’s rural communities. [from introduction]

Rural township health centres and urban community health centres play a crucial role in the delivery of primary health care in China. The limited availability and low qualifications of human resources in health are among the main challenges facing lower-level health facilities. This paper aims to analyse the mobility of health workers in township and community health centres. [from abstract]

This study investigates the influence of demographic characteristics, provincial policies, organizational changes and emerging practice challenges on the rural–urban segments of the Canadian nursing workforce in order to describe the nature of nursing work from the perspective of rural nurse executives and frontline nurses. [adapted from introduction]

This paper serves as background documentation for the first expert meeting for developing the evidence-based recommendations for increasing access to health workers in remote and rural areas through improved retention, to be held in Geneva on 2-4 February 2009. It is intended to provide an overview of the issues, challenges and potential solutions to the problem of inequitable access to health workers in remote and rural areas. [from introduction}

This presentation discusses an ineffective incentives effort to retain rural health workers and suggestions for more useful interventions.

This presentation reviews the current state of health worker retention in rural areas, discusses interventions aimed at addressing the problem and describes the challenges and directions for solving it.

This presentation outlines the World Health Organization’s (WHO) efforts to scale up health care delivery in rural areas through health care worker retention programs.

China’s long struggle with rural coverage for health care goes back to the early part of the 20th century. In 1968, the programme of barefoot doctors was introduced by the journal Red Flag as a national policy focused on quickly training paramedics to meet rural needs. Most barefoot doctors, who graduated from secondary school education, practised after training at the county or community hospital for 3—6 months. Hence medical coverage in the countryside rapidly expanded. However, the barefoot doctors, who generated their work points with medical services just like agricultural work (ie, their income was counted by transferring time for medical service to similar time for agricultural work) were not at par with the regularly trained doctors and their incomes were 50% lower. [from author]

This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993-2006). The study aimed to describe what health service models were reported to work, where they worked and why. [from abstract]

The two main objectives of this study were to examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse and identify key coping strategies used by them when in working in the rural context. [from abstract]

This summary of the 2008 Asia-Pacific Action Alliance on Human Resource for Health Conference discusses findings and recommendations from this event, as well as issues covered at the conference including development and planning of rural HRH strategy; strengthening community and rural health workers and primary healthcare; and fostering regional cooperation on HRH.

This presentation from the 2008 Asia-Pacific Action Alliance on Human Resource for Health Conference discusses the supply, demand and distribution of nurses in Thailand, as well as a Discrete Choice Experiment (DCE) to ascertain the assignment preferences of recent nursing graduates.


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This paper discusses the current health situation in eastern Indonesia and the problems facing health workers at health centers in the remote country border areas of that region. [adapted from abstract]


To view the presentation, you must have either Microsoft PowerPoint or download the free PowerPoint Viewer.

This article reports on an initiative in a rural New Zealand community to meet the need for after hours care. First contact for patients is with a community nursing team operating from the local health centre, complemented by on-call advice from GPs and GP clinics twice daily at weekends. The article reports on the demand for after hours services generated by a geographically defined community in New Zealand. [from introduction]

This presentation on health worker retention in rural area was offered during a dialogue hosted by the WHO and OECD.