Navnirman trust and Karnataka State Health Systems Resource Centre (KSHSRC)
India is a developing country with a human resource crisis in the public health sector. The government of India has undertaken several measures to attract skilled medical and para-medical professionals to work in rural areas. In Karnataka, the rural incentive scheme was introduced to encourage regular, ad hoc and contractual staff to take up posting in rural areas.
This exploratory study was conducted in select PHCs in Bagalkot, Chitradurga and Chikmagalur to gain an understanding into the rural incentive scheme primarily from the point of view of the service providers.
Although there are criteria to classify a PHC as more or most difficult, the selection of PHCs at the state level, raising awareness about the rural incentive scheme and formulation of guidelines were not done in consultation with the state health department. This has led to gaps in implementation.
Awareness among the health service personnel about the rural incentive scheme was about 70% only and only 43% were aware of the criteria to classify PHCs as more or most difficult. Staff said that factors that would motivate them to work in remote areas include availability of good educational facilities, good transport and an intrinsic desire to work in rural areas.
Although the general perception was the rural incentive scheme was good, staff felt that the amount was too low and there were delays in payment. Some staff who had availed the scheme felt that it gave them more time to do their work and also increased their attachment to the community. They felt that OPD attendance had gone up.
Concerns were raised about the lack of basic amenities like water, sanitation, residential quarters and safety for women staff. Barriers to being posted in the remote areas were poor access to essential commodities, long periods of separation from family, lack of essential drugs and equipment.
When asked about the non-financial incentives for being posted in remote area, possibility of a promotion after the rural posting was high on the list, followed by the need for continued professional education regular encouragement and support by seniors, education facilities for children, support for spouse’s occupation, inclusion of rural curriculum in training and government subsidy for further education.
Basic amenities like residential quarters, transport, electricity, drinking water and safety are pre-requisites for the incentive scheme to be of any value. These needs have to be ensured.
There should be timely disbursal of the funds for the scheme and payments made regular every three months. Lack of this leads to amotivation which is difficult to get back.
The criteria for more and most difficult PHC should be clear and widely publicized with all the medical personnel, since many of them are unaware and unclear about it.
Non financial incentives have been found to be important to encourage postings in rural areas. These include professional support, possibility of a promotion, subsidy for further education and some preferential treatment by the government in the form of loans and post graduate education. It was also found that some facility to support families to stay with the personnel would motivate them to stay at the PHC rather than financial incentives alone.
There is a need for good oversight to ensure that medical personnel do not claim the incentive without staying at the PHC. Frequent visits to address their concerns as well as to ensure that they stay would make sure that the incentive scheme is not misused.
Staff who get posted to remote areas and function well, should be recognized and awarded by the system as a form of positive re-inforcement.
Although the rural incentive scheme has been introduced with the good intention of increasing health personnel in remote areas, implementation will only happen if some basic facilities are in place. These facilities should be reviewed regularly and feedback from the staff obtained to ensure that their basic needs are met