wow-inequalities/02-data/intermediate/wos_sample/4dcef09cf75f239deb414df3eea88865-chhea-c.-and-warren/info.yaml

abstract: 'Introduction: A decade after health sector reform, public health

  services in rural Cambodia remain under-utilised for multiple reasons

  related to financial, structural and personnel factors. Ineffectiveness

  of rural public health services has led to a significant increase in

  private providers, often the same people who staff public facilities.

  Public health clinics are often portrayed as low quality, with long

  waiting times and unexpected costs; in contrast, private clinics are

  seen to provide more convenient health care. Several strategies,

  including contract management and health equity funds, have been

  introduced to improve public sector performance and encourage

  utilization; these efforts are ongoing. However, the feasibility of

  these strategies remains in question, particularly in terms of

  cost-effectiveness and sustainability.

  Methods: In this article the strategies of and barriers met by health

  workers who remain in rural areas and deliver public health services are

  elucidated. Ethnographic research conducted in 2008 with health

  providers involved in treating tuberculosis patients in Kampong Speu

  Province, Cambodia is drawn on. Participants were recruited from the

  provincial health department, provincial hospital and four health

  centres. Data collection involved in-depth interviews, participation in

  meetings and workshops aimed at health workers, and observation of daily

  activities at the health facilities. Data were transcribed verbatim,

  imported into NVivo software (www.qsrinternational.com) for management,

  and analysed using a grounded theory approach.

  Results: Primary healthcare service delivery in rural Cambodia was

  reliant on the retention of mid-level of health staff, primarily

  midwives and nurses. Its performance was influenced by institutional

  characteristics relating to the structure of the health system. Personal

  factors were impacted on by these structural issues and affected the

  performance of health staff. Institutional factors worked against the

  provision of high-quality public health services, and included the

  fragmentation of service delivery and structure, limited capacity and

  shortage of high-qualified health staff, competition with the private

  sector, and shortage of medical supplies. These factors all de-motivated

  health staff, and undermined their performance in public service

  positions. Personal factors were paramount for staff retention. These

  included: optimism and appreciation of work responsibilities and

  position, the personal ability to cope with financial barriers, and

  institutional benefits such as opportunities for professional

  development, job security, financial opportunities (via

  performance-based allowances), and status in society. Individual

  financial coping strategies were the dominant factor underlying

  retention, but alone were often de-motivating: clients were diverted

  from the public services, which led to distrust, and thus undermined the

  capacity of public system. There was significant interaction between

  institutional and personal factors, which impacted on the effectiveness

  of health staff retention in rural areas. Health workers tended to

  remain in their government positions for prolonged periods of time

  because they experienced personal rewards. At the same time, however,

  their job performance in the public health services were hindered by

  challenges related to the institutional factors.

  Conclusions: The interaction between institutional factors and personal

  factors was crucial for effectiveness of health staff retention in rural

  Cambodia. Efforts aimed at ensuring quality of care and encouraging

  health staff retention should attempt to remove the institutional

  barriers that discourage the use of rural public health services.'
affiliation: 'Chhea, C (Corresponding Author), Monash Univ, Sch Psychol Psychiat \&
  Psychol Med, Melbourne, Vic 3004, Australia.

  Chhea, C.; Warren, N.; Manderson, L., Monash Univ, Sch Psychol Psychiat \& Psychol
  Med, Melbourne, Vic 3004, Australia.'
article-number: '1391'
author: Chhea, C. and Warren, N. and Manderson, L.
author_list:
- family: Chhea
  given: C.
- family: Warren
  given: N.
- family: Manderson
  given: L.
da: '2023-09-28'
files: []
issn: 1445-6354
journal: RURAL AND REMOTE HEALTH
keywords: 'Cambodia; health personnel; institutional factors; personal factors;

  retention; rural health services'
keywords-plus: INFORMAL PAYMENTS; SECTOR REFORM; CARE; PRACTITIONERS; POOR
language: English
month: JUL-SEP
number: '3'
number-of-cited-references: '43'
orcid-numbers: 'Warren, Narelle/0000-0003-2623-4078

  Manderson, Lenore/0000-0002-7883-1790'
papis_id: 413300881de3faabd8b32e1708ebba53
ref: Chhea2010healthworker
researcherid-numbers: 'Warren, Narelle/H-9318-2019

  '
times-cited: '24'
title: Health worker effectiveness and retention in rural Cambodia
type: article
unique-id: WOS:000286342600008
usage-count-last-180-days: '0'
usage-count-since-2013: '44'
volume: '10'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2010'