title: A staff support programme for rural hospitals in Nepal.
abstract: OBJECTIVE
  District hospitals in Nepal struggle to provide essential services such as caesarean sections.
  
  
  METHODS
  Retention of health workers is critical to the delivery of long-term, quality health-care services. To promote retention and enhance performance in rural public hospitals, the Government of Nepal and the Nick Simons Institute progressively implemented a rural staff support programme in remote hospitals. After competitive selection for a compulsory-service scholarship and training, family practice doctors who could do basic surgery, orthopaedics and obstetrics were hired under a binding three-year contract in each participating hospital. Comfortable living quarters and an Internet connection were provided for the resident doctors; in-service training for all staff and capacity development for each hospital's management committee were provided.
  
  
  METHODS
  Nepal's mountainous landscape, poverty and inequitable rural/urban distribution of health workers pose barriers to adequate health care.
  
  
  RESULTS
  Between 2011 and 2015 family practice doctors were maintained in all seven programme hospitals. All hospitals became providers of comprehensive emergency obstetric care and served more patients. Compared with hospitals not within the programme, deliveries increased significantly (203% versus 71% increase, respectively; P = 0.002). The programme recently expanded to 14 hospitals.
  
  
  CONCLUSIONS
  A package of human resource supports can improve the retention of doctors and the use of remote hospitals. Factors contributing to the success of this programme were compulsory-service scholarship, central personnel management, performance-based incentives and the provision of comfortable living quarters.
authors.affiliation: Nick Simons Institute, Box 8975, EPS 1813, Kathmandu, Nepal .
authors.forename: Mark
authors.initials: M
authors.lastname: Zimmerman
authors.affiliation: Nick Simons Institute, Box 8975, EPS 1813, Kathmandu, Nepal .
authors.forename: Sharada
authors.initials: S
authors.lastname: Shah
authors.affiliation: Nick Simons Institute, Box 8975, EPS 1813, Kathmandu, Nepal .
authors.forename: Rabina
authors.initials: R
authors.lastname: Shakya
authors.affiliation: Nick Simons Institute, Box 8975, EPS 1813, Kathmandu, Nepal .
authors.forename: Bal
authors.initials: B
authors.lastname: Sundar Chansi
authors.affiliation: Nick Simons Institute, Box 8975, EPS 1813, Kathmandu, Nepal .
authors.forename: Kashim
authors.initials: K
authors.lastname: Shah
authors.affiliation: Division of Health Sciences, Warwick University, Warwick, England .
authors.forename: Daniel
authors.initials: D
authors.lastname: Munday
authors.affiliation: Harvard TH Chan School of Public Health, Harvard University, Boston, United States of America .
authors.forename: Nir
authors.initials: N
authors.lastname: Eyal
authors.affiliation: Nick Simons Institute, Box 8975, EPS 1813, Kathmandu, Nepal .
authors.forename: Bruce
authors.initials: B
authors.lastname: Hayes
mesh_terms: D057191:Capacity Building / Q000379:methods; D006780:Hospitals, Rural; D006801:Humans; D007318:Inservice Training / Q000379:methods / Q000458:organization & administration / Q000592:standards; D008505:Medical Staff, Hospital / Q000193:education / Q000458:organization & administration* / Q000600:supply & distribution; D009390:Nepal; D019982:Organizational Case Studies; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration / Q000592:standards; D010563:Personnel Turnover / Q000639:trends; D010821:Physicians, Family / Q000193:education / Q000458:organization & administration* / Q000600:supply & distribution; D015397:Program Evaluation; D058996:Quality Improvement; D012944:Social Support; D000078329:Workforce