title: Developing effective policy strategies to retain health workers in rural Bangladesh: a policy analysis.
abstract: BACKGROUND
  Retention of human resources for health (HRH), particularly physicians and nurses in rural and remote areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to develop appropriate rural retention strategies in Bangladesh.
  
  
  METHODS
  We conducted a document review, thorough search and review of relevant literature published from 1971 through May 2013, key informant interviews with policy elites (health policy makers, managers, researchers, etc.), and a roundtable discussion with key stakeholders and policy makers. We used the World Health Organization's (WHO's) guidelines as an analytical matrix to examine the rural retention policies under 4 domains, i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and 16 sub-domains.
  
  
  RESULTS
  Over the past four decades, Bangladesh has developed and implemented a number of health-related policies and provisions concerning retention of HRH. The district quota system in admissions is in practice to improve geographical representation of the students. Students of special background including children of freedom fighters and tribal population have allocated quotas. In private medical and nursing schools, at least 5% of seats are allocated for scholarships. Medical education has a provision for clinical rotation in rural health facilities. Further, in the public sector, every newly recruited medical doctor must serve at least 2 years at the upazila level. To encourage serving in hard-to-reach areas, particularly in three Hill Tract districts of Chittagong division, the government provides an additional 33% of the basic salary, but not exceeding US$ 38 per month. This amount is not attractive enough, and such provision is absent for those working in other rural areas. Although the government has career development and promotion plans for doctors and nurses, these plans are often not clearly specified and not implemented effectively.
  
  
  CONCLUSIONS
  The government is committed to address the rural retention problem as shown through the formulation and implementation of related policies and strategies. However, Bangladesh needs more effective policies and provisions designed specifically for attraction, deployment, and retention of HRH in rural areas, and the execution of these policies and provisions must be monitored and evaluated effectively.
authors.affiliation: International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh. lbrawal@gmail.com.|James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh. lbrawal@gmail.com.|Centre for Equity and Health Systems, icddr,b, 68, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. lbrawal@gmail.com.
authors.forename: Lal B
authors.initials: LB
authors.lastname: Rawal
authors.affiliation: James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh. taufiquejoarder@gmail.com.|Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205, USA. taufiquejoarder@gmail.com.
authors.forename: Taufique
authors.initials: T
authors.lastname: Joarder
authors.affiliation: International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh. shariful.islam@icddrb.org.
authors.forename: Sheikh Md Shariful
authors.initials: SM
authors.lastname: Islam
authors.affiliation: International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh. aftab@icddrb.org.
authors.forename: Aftab
authors.initials: A
authors.lastname: Uddin
authors.affiliation: International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh. ahmed.sm@bracu.ac.bd.|James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh. ahmed.sm@bracu.ac.bd.
authors.forename: Syed Masud
authors.initials: SM
authors.lastname: Ahmed
mesh_terms: D001459:Bangladesh; D002648:Child; D003695:Delivery of Health Care; D003906:Developing Countries; D004501:Education, Medical; D004506:Education, Nursing; D004517:Education, Professional; D006268:Health Facilities; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D009726:Nurses; D010563:Personnel Turnover; D010820:Physicians; D011050:Policy Making; D017150:Public Sector; D019035:Rural Health Services; D012424:Rural Population; D012456:Salaries and Fringe Benefits; D000078329:Workforce