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Distribution - Which interventions increase the proportion of health professionals practising in rural and underserved areas?

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The inequitable distribution of health professionals, including in high-, middle- and low-income countries, poses an important obstacle to the achievement of health for all, which is regarded as a fundamental human right.

Key messages

- There is little rigorous evidence to support any financial, regulatory, selection or training strategy to improve the distribution of health professionals:

The following key messages are based on very low quality evidence:

- Health professionals from rural backgrounds are more likely to practice in rural areas
- Evidence from 4 quasi-randomised trials suggests that clinical rotations in a rural setting may influence medical students subsequent decisions to work in an underserved area
- The effectiveness of compulsory placement has been assessed by descriptive surveys with inconclusive results
- Loan repayments, direct incentives and medical resident-support programmes to encourage rural placement have the highest service completion rates and physician retention rates

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