Skilled doctors lack incentives to work in poor, remote localities

A shortage of medical equipment, poor facilities and low payment are the barriers preventing doctors, especially those with skills, from working in disadvantaged areas.

Experts said this negative assessment was a fact despite efforts by health authorities to create policies to attract top talent from the cities.

Mai Xuan Hai, director of the Central Highland province of Gia Lai's Health Department said it was difficult to attract doctors, especially post-graduates to work for district-level hospitals.

In communes, the situation is more grim. Most health staff at this level had only taken part in "crash courses" in medical treatment, Hai said.

He said the department had created a policy to provide more than 140 per cent of the basic wage for doctors. However, few university-graduated doctors have shown any interest.

Figures from the department showed that there were 743 doctors in the province. Of these, only 150 were working in communal health clinics. About 30 per cent of communes had no doctors at all.

Nguyen Van Hai, director of central Quang Nam Province, said the provincial authority had issued a policy that doctors who volunteered to move to remote areas would receive between VND200-500 million (US$9,360-23,420) and support in accommodation.

However, the policy did not work, he said.

Statistics from the Ministry of Health reveal that there is a serious shortage of health staff in the northern region, the Central Highland and the Mekong Delta region.

In the Mekong Delta region alone, there is a need for more than 3,000 doctors and 650 pharmacists.

According to the ministry, the situation has arisen not only because of poor policies and low payments, but also because of poor working conditions, shortages of medical equipment and poor facilities.

Doctor Loc Dang Sao, who has been working at Lang Khe Commune Health Clinic in central Nghe An Province for 18 years, said he was so nervous when dealing with complicated baby deliveries or serious traumas as there were no medical tools available for this job.

Sao said the district hospital was 25 kilometres away, thus he sometimes had to give emergency treatment to patients to save their lives.

He said that his income, including wage and an additional payment for doctors in remote areas according to the ministry's regulation, was VND7 million ($327), much lower than his colleagues on the plains.

Le Thi Nhi, a midwife in central Quang Nam Province's Phuoc Kim Commune, said after 20 years of working, the facilities of the clinic had not improved much.

Nhi cited the delivery of a baby to a 17-year-old mother last September. When she managed to get the woman to the hospital 20km away, doctors could not keep the baby alive.

Pham Van Tac, head of the ministry's Department of Personnel and Organisation, said that health authorities had been told to hasten the movement of young doctors to remote, mountainous, island and border areas, focusing in the country's 62 poor districts.

It is intended to send about 500 young doctors with strong study results from four medical universities in Ha Noi, Thai Binh, Hai Phong and Thai Nguyen for a further 18-month training course before going to work in deprived areas by 2016.

Moreover, the ministry has asked large hospitals to transfer technology to district-level hospitals. The provision of more than VND495 billion ($23.1 million) from the State budget is also expected to help doctors in remote areas.

Minister of Health Nguyen Thi Kim Tien said the ministry planned to build 70 health clinics in 14 northern mountainous areas for a cost of VND310 billion ($14.5 million).

The ministry would also give priority to upgrading health clinics and purchasing quality medical equipment in the future.

It was also building a programme to rotate doctors from central and district hospitals to work in disadvantaged areas.


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