RETENTION OF FULL TIME HUMAN RESOURCES IN HEALTH CARE FACILITIES: EXPERIENCE FROM A LARGE SCALE PILOT IN BANGLADESH


Background: The prevalent system of private practice or second job by institutionally appointed physicians and other providers is a great obstacle for ensuring good health care to the people in most of the developing countries. This creates particular problem for diabetes and other NCDs which need regular lifelong care where uninterrupted relation with the providers is essential.
Aim: The present study reports the experience of a large scale piloting through Health Care Development Project (HCDP), operated by the Diabetic Association of Bangladesh, where all providers were employeed on a full-time commitment basis with institutional practicing opportunity for the physicians.
Materials & Methods: The study was conducted on the HCDP facilities comprising of 20 hospitals and health centres located in both urban and rural areas. Presently 1320 employees (physicians 215, nurses 154, technicians 331 and others 620) work in various facilities of the Project. Data regarding employment and resignation/termination were collected from the hospital records and retention rate was calculated on yearly basis (Jan-Dec). The remuneration for the Providers in the Project were compared with that offered by the public sector. The factor underlying non-retention of HR were also explored and analyzed.
Result: During the last 12 years a total of 9.9m (7.3m, ie 73.97% diabetic) received service through the Project Facilities. The number increased by about 7 times over the last 12 years. The average HR retained in the project over the last 12 years is 93.61% and it did not vary substantially from year to year (range 89% to 97%). The retention was lowest in case of physicians (86.93%) followed by nurses (88.44%), other employees (95.70%) and technicians (96.72%). The average remuneration to the physicians were about 100% higher and to other employees were about 50% higher in HCDP compared to the public sector employees. Higher level physicians had additional institutional practice with variable percentages of remuneration on fees depending on the level of their qualification and experience. Analysis of factors regarding non-retention revealed that proper and regular financial remuneration, job satisfaction and governance issues are the most important factors in retaining HR in this system.
Conclusion: Full time commitment of health care providers, including physicians, is feasible even in a developing country with due consideration of financial benefit, job satisfaction and governance issues.

Retention of full time human resources in health care facilities: experience from a large scale pilot in Bangladesh