Retention of doctors in rural health services in Thailand: impact of a national collaborative approach.

INTRODUCTION: Little evidence exists about the impact of strategies to increase rural retention in developing countries. To address Thailand's long-lasting critical shortage of doctors, two new government-funded projects to increase the production of rural doctors have been employed through collaboration between the Ministry of Education and the Ministry of Public Health (MOPH). The present study describes the impact of this national collaborative approach on production and retention of doctors in rural health services.

METHODS: In addition to a conventional track of medical training, a special recruitment initiative, including two special projects, called the Collaborative Project to Increase Production of Rural Doctor and One District One Doctor, were launched in 1994 and 2005 respectively. This special recruitment initiative involves partnership between 14 universities and 37 accredited hospitals in the MOPH. Doctor retention in the MOPH health services up to 1 June 2016 was compared across the two training tracks using χ2 test. Factors associated with 3-year retention in the MOPH health services were identified using multiple logistic regression.

RESULTS: The overall and year-by-year retention of medical graduates under the special recruitment track was higher than the normal track (overall retention of 78.2% and 52.5% respectively, <i>p</i><0.05). Compared to their normal track counterparts, medical graduates under the special recruitment scheme were about 2.4-fold more likely to remain working in the MOPH health services for a minimum period of 3 years (odds ratio 2.44, 95% confidence interval 2.19-2.72). Among 4869 medical graduates under the special recruitment track who remained working for the MOPH, 4425 (90.9%) still worked in the provinces to which they were primarily assigned.

CONCLUSIONS: A national collaborative approach to increasing production of rural doctors was effective at enhancing retention of doctors in rural areas. Challenges remain to overcome uneven cross-region doctor density and maldistribution.