title: Compulsory service programmes for recruiting health workers in remote and rural areas: do they work?
abstract: Compulsory service programmes have been used worldwide as a way to deploy and retain a professional health workforce within countries. Other names for these programmes include "obligatory", "mandatory", "required" and "requisite." All these different programme names refer to a country's law or policy that governs the mandatory deployment and retention of a heath worker in the underserved and/or rural areas of the country for a certain period of time. This study identified three different types of compulsory service programmes in 70 countries. These programmes are all governed by some type of regulation, ranging from a parliamentary law to a policy within the ministry of health. Depending on the country, doctors, nurses, midwives and all types of professional allied health workers are required to participate in the programme. Some of the compliance-enforcement measures include withholding full registration until obligations are completed, withholding degree and salary, or imposing large fines. This paper aims to explain these programmes more clearly, to identify countries that have or had such programmes, to develop a typology for the different kinds and to discuss the programmes in the light of important issues that are related to policy concepts and implementation. As governments consider the cost of investment in health professionals' education, the loss of health professionals to emigration and the lack of health workers in many geographic areas, they are using compulsory service requirements as a way to deploy and retain the health workforce.
authors.affiliation: Department of Health Policy, George Washington University, 2121 K Street NW, Washington, DC 20006, United States of America. seblelf@gwu.edu
authors.forename: Seble
authors.initials: S
authors.lastname: Frehywot
authors.forename: Fitzhugh
authors.initials: F
authors.lastname: Mullan
authors.forename: Perry W
authors.initials: PW
authors.lastname: Payne
authors.forename: Heather
authors.initials: H
authors.lastname: Ross
mesh_terms: D014943:Global Health; D019538:Health Care Surveys; D006282:Health Personnel / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D037141:Mandatory Programs / Q000458:organization & administration*; D009042:Motivation; D010563:Personnel Turnover; D019035:Rural Health Services / Q000458:organization & administration*; D014944:World Health Organization
references.citation: Rural Remote Health. 2008 Jul-Sep;8(3):930
references.pmid: 18643712
references.citation: Aust J Rural Health. 2008 Jun;16(3):150-5
references.pmid: 18471185
references.citation: East Mediterr Health J. 2007 Nov-Dec;13(6):1466-75
references.pmid: 18341196
references.citation: Aust J Rural Health. 2004 Jun;12(3):104-11
references.pmid: 15200520
references.citation: J Rural Health. 2005 Winter;21(1):1-2
references.pmid: 15667003
references.citation: BMC Health Serv Res. 2008 Jan 23;8:19
references.pmid: 18215313
references.citation: Hum Resour Health. 2009 Jun 26;7:52
references.pmid: 19558682
references.citation: Hum Resour Health. 2003 Nov 25;1(1):12
references.pmid: 14641940
references.citation: S Afr Med J. 2001 Apr;91(4):329-36
references.pmid: 11402906
references.citation: Hum Resour Health. 2008 Sep 15;6:18
references.pmid: 18793436
references.citation: Rural Remote Health. 2005 Oct-Dec;5(4):460
references.pmid: 16313202
references.citation: Soc Sci Med. 1998 Dec;47(12):1937-46
references.pmid: 10075237
references.citation: Hum Resour Health. 2005 Jan 19;3(1):1
references.pmid: 15659241
references.citation: Med J Malaysia. 2005 Aug;60 Suppl D:28-31
references.pmid: 16315620
references.citation: Hum Resour Health. 2003 Oct 28;1(1):8
references.pmid: 14613524
references.citation: J Public Health Policy. 1981 Mar;2(1):70-4
references.pmid: 7298834
references.citation: S Afr Med J. 2006 Aug;96(8):676-7
references.pmid: 17019486