oa Stakeholder' perspectives on optimal recruitment and retention strategies for health human resources in primary health care centers

Purpose The first stage of this QNRF funded study includes a series of key informants' interviews with stakeholders in the PHC sector in Lebanon and Qatar to formulate an understanding of the recruitment and retention strategies of health human resources (HHR) and understand the obstacles and challenges that they face. This abstract reports on the findings obtained in Lebanon, as data collection remains ongoing in Qatar. Participants & Methods Study utilized a qualitative design involving semi-structured key informant interviews with stakeholders in the PHC sector. An initial list of key stakeholders was acquired from a review of public and private information sources while ensuring maximum variability across institutions, disciplines and geographical locations. Overall, 22 key informants participated in the study. They included decision and policy makers in the PHC sector, managers/directors of PHCCs, human resources coordinators in PHCCs, physicians and nurses, and academicians. Analysis Thematic and content analysis, using Nvivo 8, was conducted on the data collected from the key informant interviews. After coding the responses into similar concepts, axial coding allowed for the emergence of five comprehensive themes: perception of PHC, PHC services, recruitment of HHR in PHC, retention of HHR in PHC, and recruitment and retention in rural areas. Results Responses of stakeholders with regards to the definition of PHC revealed a lack of a unified understanding of the concept. With regards to services offered at PHCCs, there was a consensus that there is a deficiency in various services, most notably was mental health, as well as various preventive functions such as vaccination, women's health, and health behavior modification. Thematic analysis identified a number of impediments to the recruitment of HHR, mainly related to shortage in the overall supply of HHR, of qualified HHR, and HHR gender imbalances. Despite recruitment strategies in place, factors including financial constraints and poor leadership/management hinder the effectiveness of recruitment efforts. Although stakeholders report an acceptable retention of HHR, they relate turnover to poor working environment and lack of professional development. There was consensus that challenges faced are more pronounced in PHCCs of rural areas. Conclusions The study findings reveal that the current status of recruitment and retention within the PHC sector is not conducive to a solid and stable workforce. There is an evident need for the establishment of a unified contextualized definition of PHC to be applied across all PHCCs operating nationally. Moreover, the adoption of a system's thinking approach is crucial for PHC capacity building, in which the existent structure is better supported by qualified personnel. Extensive efforts need to be exerted towards directing health care professionals to the PHC field especially in rural areas, while concurrently enhancing the working conditions within PHCCs. Accordingly, essential services may be more adequately provided to the community. Of particular importance is the integration of mental health services into community care. Decision and policy makers are urged to reflect upon the recommendations developed in order to not only stabilize the PHC workforce but to also ensure the longevity of its services.