Table 1.

Interventions used to improve attraction, recruitment, and retention of health workers in rural and remote areas in select low‐ and middle‐income countries in the EMR (based on WHO recommendation) ¹¹

Countries/Categories	Education	Regulatory	Financial	Personal
Examples from the global recommendations 11	Students from rural background Health professional schools outside of major cities Clinical rotations in rural areas Curricula that reflects rural health issues Continuous professional development for rural health workers	Enhanced scope of practice Different types of health workers Compulsory service Subsidized education for return of service	Appropriate financial incentives	Better living conditions Safe and supporting working environment Outreach support Career development programs Professional networks Public recognition
Afghanistan 14	Recruiting students from rural backgrounds (through community nursing [CHN] and midwifery education [CM]) Increasing more training institutes in remote provinces (through IHS/CME) National midwifery accreditation program (tailored to rural deployment) CHW/CHN/CM curricula are based on rural health issues Continuous professional development (refresher courses for CHW) Consideration of preferential admission to meet quotas and rural rotations	Introducing new cadres Enhancing scope of practice, especially for CHN, CM	Hardship allowances (double for women in rural care)	Providing opportunities to male family members Public recognition measures, especially for community health workers, nurses and midwives Afghan midwifery Association (CPD, network)
Egypt 24 , 25 , 26	Opening medical colleges and health institutes in rural areas	Raedat refiyat (RR): Female community health workers recruited and deployed in rural areas	Rural hardship allowances	MOH provides housing, attached to PHCs
Iraq 15 , 27	Bridge programs/certificates/diplomas in family medicine and nursing Establishing fellowships for CPD Online courses for in‐service training	Mandatory 1 year service in rural PHC	Incentive bundles	Improving living standards Creating compounds for health workers next to medical facilities
Islamic Republic of Iran 2 , 12 , 22 , 28	Opening medical colleges in rural areas Recruiting health workers from rural areas	Compulsory service special underserved areas (usually in rural areas) Introducing behvarz (community health workers)	Financial incentives
Jordan 17 , 18 , 29	Continuous education (specialization in Family Medicine) Providing some internships in (rural) PHCs MOH initiative for rural medical schools rotations to enhance rural exposure	Female community health workers recruited and deployed in rural areas (only in the South)	Rural hardship allowances
Lebanon 2 , 16 , 17 , 30	Targeted scholarships for rural background students, bonding return of service agreements	Introducing a rural nurse cadre Improved supervisor support through preceptors	Financial incentives (eg, bonuses, raises, tuition reimbursements) Rural reimbursement policies exist (but not effective or strong enough)	Professional development through seminars, courses, and access to conferences, professional development Order of nurses (for those working in rural PHCs) Improving work environments and boosting infrastructure (through contracting out PHCs)
Pakistan 21 , 28 , 31	Changes in curricula Increasing number of training institutions in rural areas	Introducing new cadres, such as lady health workers and lady health visitors, community midwives recruited from, trained and deployed to all districts Training male CHW		Fringe benefits, housing facilities and career development opportunities (specifically for doctors)
Somalia 20 , 28	Public‐private partnerships in training institutions to increase quality and access Course standardization and changes in curricula Expanding health training institutes in remote areas	Introducing and training midlevel professionals such as midwives, nurses, sanitarians, allied health workers, lab techs Introducing CHWs, especially female health workers and community midwives 1 year mandatory national service post‐graduation (but poor implementation)	Creating a multisource fund from UN donors to support CHWs Harmonizing salary remunerations for public health workers, Introducing standardized regular living salaries and special hardship allowances for rural, remote and insecure areas	Introducing better gender‐policies Improving career development policies Introducing workplace safety and security measures Increasing available technologies and equipment Providing recognition and awards Establishing regulatory health professional councils and associations for licensing, networking, credentialing of new cadres
Sudan 13 , 32 , 33	Increasing number of training institutions in rural areas	Establishing law enforcement units in health facilities to ensure policy compliance Compulsory year in PHC (but poor enforcement) Introducing new cadres, recruiting and deploying lower cadres (nurses, med assistant and midwives) in rural areas	Financial incentives Scholarships	Upgrading PHC infrastructure and facilities Fringes, rural allowances, (such as health insurance, car ownership), housing subsidies Better gender‐policies to ensure female retention in rural areas

Abbreviations: EMR, Eastern Mediterranean Region; PHCs, primary healthcare centers.