title: Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis.
abstract: Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas.
  
  
  
  We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low- and middle-income countries.
  
  
  
  Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban-rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions-are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas.
  
  
  
  A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence- based strategies are needed to ensure context-specific, field- tested and cost-effective solutions to various existing problems. To ensure retention these strategies must be integrated with effective human resource management policies and rural orientation of the medical education system.
authors.affiliation: School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012. India.
authors.forename: Sonu
authors.initials: S
authors.lastname: Goel
authors.affiliation: Department of Health Services Research, Maastricht University, The Netherlands.
authors.forename: Federica
authors.initials: F
authors.lastname: Angeli
authors.affiliation: Department of Community Medicine, Army College of Medical Sciences, New Delhi, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Bhatnagar
authors.affiliation: School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012. India.
authors.forename: Neetu
authors.initials: N
authors.lastname: Singla
authors.affiliation: Immunization Technical Support Unit, Public Health Foundation of India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Grover
authors.affiliation: Department of Health Services Research, Maastricht University, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Maarse
mesh_terms: D003695:Delivery of Health Care; D006282:Health Personnel / Q000706:statistics & numerical data*; D006280:Health Workforce / Q000458:organization & administration; D006801:Humans; D007194:India; D008507:Medically Underserved Area; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration*