title: Indian approaches to retaining skilled health workers in rural areas.
abstract: OBJECTIVE
  The lack of skilled service providers in rural areas of India has emerged as the most important constraint in achieving universal health care. India has about 1.4 million medical practitioners, 74% of whom live in urban areas where they serve only 28% of the population, while the rural population remains largely underserved.
  
  
  METHODS
  The National Rural Health Mission, launched by the Government of India in 2005, promoted various state and national initiatives to address this issue. Under India's federal constitution, the states are responsible for implementing the health system with financial support from the national government.
  
  
  METHODS
  The availability of doctors and nurses is limited by a lack of training colleges in states with the greatest need as well as the reluctance of professionals from urban areas to work in rural areas. Before 2005, the most common strategy was compulsory rural service bonds and mandatory rural service for preferential admission into post-graduate programmes.
  
  
  RESULTS
  Initiatives under the National Rural Health Mission include an increase in sanctioned posts for public health facilities, incentives, workforce management policies, locality-specific recruitment and the creation of a new service cadre specifically for public sector employment. As a result, the National Rural Health Mission has added more than 82,343 skilled health workers to the public health workforce.
  
  
  CONCLUSIONS
  The problem of uneven distribution of skilled health workers can be solved. Educational strategies and community health worker programmes have shown promising results. Most of these strategies are too recent for outcome evaluation, although this would help optimize and develop an ideal mix of strategies for different contexts.
authors.affiliation: National Health Systems Resource Centre, National Institute of Health and Family Welfare, Baba Gang Nath Marg, Munirka, New Delhi, India.
authors.forename: Thiagarajan
authors.initials: T
authors.lastname: Sundararaman
authors.forename: Garima
authors.initials: G
authors.lastname: Gupta
mesh_terms: D006280:Health Workforce / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007194:India; D009726:Nurses; D010820:Physicians; D015980:Public Health Practice; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D012456:Salaries and Fringe Benefits