Earlier this month, the World Health Organization released its new policy recommendations on how to better retain health workers: “Increasing access to health workers in remote and rural areas through improved retention.” These guidelines offer ways to mitigate the continued high rates of migration of rural health workers, which leaves as many as a billion people in the developing world without access to essential health services. The new policy document is designed to help policy-makers create regulations, invest in infrastructure, and offer benefits that make working in the rural health sector more attractive.

The report finds that health workers are migrating at an increasing rate—both in developed and developing countries. The report documents the common migration pattern of health workers in the developing world from poor communities in rural areas to nearby cities within the country and then later to larger cities in the same region before finally seeking work abroad in a wealthier country. The report suggests that better pay isn't the only lure: political instability, the quality of governance, career prospects, and the threat of violence in the workplace fuel health workers relocation choices.

In some countries, more than 50 percent of highly-trained health workers leave for work abroad. The causes and implications of this movement emerge from and feed a range of social conditions. The new report stresses that policy-makers should comprehensively address the motivations for health worker migration including by:

• Recruiting students from rural areas
• Expanding curricula across the board to include coverage of rural health topics
• Expanding continuing education to build on the existing skills and training for rural workers
• Improving working conditions and providing other incentives to make rural practice more attractive, secure, and practical
• Funding a range of benefits that make careers in rural areas more secure and comfortableeven when there are limits to pay increases 
• Investigating how housing grants, paid vacations, free transportation, hardship stipends and other benefits could boost worker satisfaction and retention
• Improving working conditions, including worker safety
• Developing infrastructure and social services that improve the lives of workers' families, including schools, telecommunications, and sanitation
• Supporting professional networks that allow rural workers to engage with their counterparts in cities
• Creating public recognition mechanisms that raise the prestige of working in poor places.

Globalization is making migration easier, and the demand for health workers in wealthy countries is likely to increase. Migration benefits local economies, too, as remittances from the emigrants help to stream cash back into poor economies, and has been associated with a drop in poverty in some areas. All of these realities make the challenges of health worker recruitment and retention even more difficult, but it’s a problem we cannot afford to ignore.

For more on this topic check out the World Health Organization’s Global Code of Practice on the International Recruitment of Health Personnel released in May.