title: A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh.
abstract: BACKGROUND
  Bangladesh is a highly populous country with three-quarters rural population. Pressing national shortages in health professionals has resulted in high vacancy rates in rural areas. These are compounded by excessive absenteeism and low retention among nurses and doctors posted to rural locations. This study attempts to ascertain reasons for providers' reluctance to work in rural and remote areas and to identify ways in which these barriers to appropriate staffing might be resolved.
  
  
  METHODS
  This is a qualitative study based on in-depth interviews with healthcare providers (n = 15) and facility managers (n = 4) posted in rural areas, and key informant interviews with health policymakers at the national level (n = 2). Interview guides were written in English and translated and administered in Bengali. The collected data were re-translated and analyzed in English. Braun and Clarke's thematic analysis approach (data familiarization, coding, identifying and reviewing themes, and producing a final report) was used.
  
  
  RESULTS
  Participants reported poor living conditions in rural areas (e.g., poor housing facilities and unsafe drinking water); overwhelming workloads with poor safety and insufficient equipment; and a lack of opportunities for career development, and skill enhancement. They reported insufficient wages and inadequate opportunities for private practice in rural areas. Managers described their lack of sufficient authority to undertake disciplinary measures for absenteeism. They also pointed at the lack of fairness in promotion practices of the providers. Policymakers acknowledged unavailability or insufficient allowances for rural postings. There is also a lack of national policy on rural retention.
  
  
  CONCLUSIONS
  The findings revealed a complex interplay of factors influencing doctors' and nurses' availability in rural and remote public health facilities from the perspective of different players in the healthcare delivery system of Bangladesh. In addition, the study generated several possibilities for improvement, including increased allowances and incentives for rural posting; a transparent and fair promotion system for serving in rural areas; enhanced authority of the local managers for reducing worker absenteeism; and improved national policies on rural retention.
authors: Dodowa Health Research Center Accra Apetechi, Greater Accra Region, Ghana. ekdarkwa@gmail.com.
authors: Emmanuel Kwame
authors: EK
authors: Darkwa
authors: Independent Scholar, Mohakhali, Bangladesh. msophnewman@gmail.com.
authors: M Sophia
authors: MS
authors: Newman
authors: James P. Grant School of Public Health, BRAC University, ICDDR, B Building, Sixth Floor, Mohakhali, Dhaka, 1212, Bangladesh. kawkab@bracu.ac.bd.
authors: Mahmud
authors: M
authors: Kawkab
authors: Centre for Equity and Health Systems (CEHS), International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh. melahi@icddrb.org.
authors: Mahbub Elahi
authors: ME
authors: Chowdhury
mesh_terms: D001459:Bangladesh; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009726:Nurses; D010558:Personnel Loyalty; D010820:Physicians; D036301:Qualitative Research; D019035:Rural Health Services; D012424:Rural Population; D012456:Salaries and Fringe Benefits; D000078329:Workforce; D016526:Workload