Compulsory service programmes for recruiting health workers in remote and rural areas: do they work?
Open accessAbstract
Compulsory service programmes have been used worldwide as a way to deploy and retain a professional health workforce within countries. Other names for these programmes include "obligatory", "mandatory", "required" and "requisite." All these different programme names refer to a country's law or policy that governs the mandatory deployment and retention of a heath worker in the underserved and/or rural areas of the country for a certain period of time. This study identified three different types of compulsory service programmes in 70 countries. These programmes are all governed by some type of regulation, ranging from a parliamentary law to a policy within the ministry of health. Depending on the country, doctors, nurses, midwives and all types of professional allied health workers are required to participate in the programme. Some of the compliance-enforcement measures include withholding full registration until obligations are completed, withholding degree and salary, or imposing large fines. This paper aims to explain these programmes more clearly, to identify countries that have or had such programmes, to develop a typology for the different kinds and to discuss the programmes in the light of important issues that are related to policy concepts and implementation. As governments consider the cost of investment in health professionals' education, the loss of health professionals to emigration and the lack of health workers in many geographic areas, they are using compulsory service requirements as a way to deploy and retain the health workforce.
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South Africa is one of 70 countries globally that implements compulsory community service.
“Frehywot et al., [9] in their study of compulsory service programmes worldwide, found that SA is one of 70 countries globally that implements compulsory CS. [9]”
From Compulsory community service for doctors in South Africa: A 15-year review (2018) · cites this paper as [9]
The Methods and Community support sections identify South Africa as having a compulsory service programme. The Introduction and Results report more than 70 countries with current or past programmes, not exactly 70 countries currently implementing them. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCompulsory service programmes are a mechanism for staffing and reinforcing the health workforce, especially in areas where access to primary and essential healthcare services and systems are weak, but this should not be the only mechanism.
“They concluded that compulsory service programmes are a mechanism for staffing and reinforcing the health workforce, especially in areas where access to primary and essential healthcare services and systems are weak, but this should not be the only mechanism.”
From Compulsory community service for doctors in South Africa: A 15-year review (2018) · cites this paper as [9]
Compulsory service programmes enable governments to direct or augment health services to geographical areas that are not well served and in communities that are not favoured by market forces and health worker preferences.
“Compulsory service programmes are an instrument of social justice, an exercise in health equity, in that they enable governments to direct or augment health services to geographical areas that are not well served and in communities that are not favoured by market forces and health worker preferences.”
From Compulsory community service for doctors in South Africa: A 15-year review (2018) · cites this paper as [9]
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References 23 · Cited by 233
Research works printed but not linked: 23
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- Authors
- Frehywot, S., Mullan, F., Payne, P. W., & Ross, H.
- Affiliations
- George Washington University (US)
- ORCID
- Frehywot, Seble
- Venue
- Bulletin of the World Health Organization
- Publisher
- WHO Press
- Published
- 2010-05-01
- Volume
- 88
- Issue
- 5
- Pages
- 364-370
- ISSN
- 0042-9686 (ISSN-L)
- PMC
- PMC2865657
- OpenAlex
- W2031454736
- Cited by
- 233
- References
- 23
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 24 · 2023: 9 · 2022: 19 · 2021: 17 · 2020: 17 · 2019: 15 · 2018: 16 · 2017: 15 · 2016: 6 · 2015: 20 · 2014: 20 · 2013: 13 · 2012: 12
- FWCI
- 18.07
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Bulletin of the World Health Organization (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Keywords
- health workforce deployment, health workforce retention, rural health workers, remote areas, health professional migration, health workforce policy, health professions education, policy implementation, compliance enforcement
- MeSH terms
- Health Personnel, Health Policy, Humans, Motivation, Personnel Turnover, Global Health, World Health Organization, Rural Health Services, Health Care Surveys, Mandatory Programs
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