A technical framework for costing health workforce retention schemes in remote and rural areas

This paper proposes a framework for carrying out a costing analysis of interventions to increase the availability of health workers in rural and remote areas with the aim to help policy decision makers. It also underlines the importance of identifying key sources of financing and of assessing financial sustainability.The paper reviews the evidence on costing interventions to improve health workforce recruitment and retention in remote and rural areas, provides guidance to undertake a costing evaluation of such interventions and investigates the role and importance of costing to inform the broader assessment of how to improve health workforce planning and management.We show that while the debate on the effectiveness of policies and strategies to improve health workforce retention is gaining impetus and attention, there is still a significant lack of knowledge and evidence about the associated costs. To address the concerns stemming from this situation, key elements of a framework to undertake a cost analysis are proposed and discussed.These key elements should help policy makers gain insight into the costs of policy interventions, to clearly identify and understand their financing sources and mechanisms, and to ensure their sustainability.Despite human resources for health having been recognized as a cornerstone to achieving better health outcomes [1], there remains a critical shortage of health workers, particularly in remote and rural areas where health outcomes tend to be significantly lower [2] and there is a considerable need for more basic health care.Increasing the availability of health workers in remote and rural areas through improved health workforce attraction and retention is therefore crucial, not only to improve population health, but also to reach the targets set out by the health-related Millennium Development Goals [3]. Responses to increasing the availability of health workers in remote and rural areas have included a variety of initiatives at nati