title: A rapid review of the rate of attrition from the health workforce.
abstract: Attrition or losses from the health workforce exacerbate critical shortages of health workers and can be a barrier to countries reaching their universal health coverage and equity goals. Despite the importance of accurate estimates of the attrition rate (and in particular the voluntary attrition rate) to conduct effective workforce planning, there is a dearth of an agreed definition, information and studies on this topic.
  
  
  
  We conducted a rapid review of studies published since 2005 on attrition rates of health workers from the workforce in different regions and settings; 1782 studies were identified, of which 51 were included in the study. In addition, we analysed data from the State of the World's Midwifery (SoWMy) 2014 survey and associated regional survey for the Arab states on the annual voluntary attrition rate for sexual, reproductive, maternal and newborn health workers (mainly midwives, doctors and nurses) in the 79 participating countries.
  
  
  
  There is a diversity of definitions of attrition and barely any studies distinguish between total and voluntary attrition (i.e. choosing to leave the workforce). Attrition rate estimates were provided for different periods of time, ranging from 3 months to 12 years, using different calculations and data collection systems. Overall, the total annual attrition rate varied between 3 and 44% while the voluntary annual attrition rate varied between 0.3 to 28%. In the SoWMy analysis, 49 countries provided some data on voluntary attrition rates of their SRMNH cadres. The average annual voluntary attrition rate was 6.8% across all cadres.
  
  
  
  Attrition, and particularly voluntary attrition, is under-recorded and understudied. The lack of internationally comparable definitions and guidelines for measuring attrition from the health workforce makes it very difficult for countries to identify the main causes of attrition and to develop and test strategies for reducing it. Standardized definitions and methods of measuring attrition are required.
authors.affiliation: ICS Integrare, calle Balmes 30,3-1a, 08007, Barcelona, Spain. sofia.lopes@icsintegrare.org.
authors.forename: Sofia
authors.initials: S
authors.lastname: Castro Lopes
authors.affiliation: ICS Integrare, calle Balmes 30,3-1a, 08007, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Guerra-Arias
authors.affiliation: Queen Margaret University, Edinburgh, Scotland, United Kingdom.|University of Technology, Sydney, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Buchan
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 1SH, United Kingdom.
authors.forename: Francisco
authors.initials: F
authors.lastname: Pozo-Martin
authors.affiliation: ICS Integrare, calle Balmes 30,3-1a, 08007, Barcelona, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Nove
mesh_terms: D004641:Emigration and Immigration; D005260:Female; D014943:Global Health; D000069576:Health Equity; D006282:Health Personnel; D006801:Humans; D007231:Infant, Newborn; D008877:Middle East; D008880:Midwifery; D009726:Nurses; D010563:Personnel Turnover; D010820:Physicians; D011247:Pregnancy
keywords: Attrition; Brain drain; Equity; Health workforce; Human resources for health; Losses; Retention; Turnover; Universal health coverage; Wastage