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Motivation and retention of health workers in developing countries: a systematic review

  • Mischa Willis-Shattuck1,
  • Posy Bidwell1,
  • Steve Thomas1Email author,
  • Laura Wyness2,
  • Duane Blaauw3 and
  • Prudence Ditlopo3
BMC Health Services Research20088:247

Received: 13 May 2008

Accepted: 04 December 2008

Published: 04 December 2008

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Archived Comments

  1. The potential benefits of aspirin in developing countries

    23 January 2009

    Gareth Morgan, Welsh Assembly Government

    The systematic review of motivation and retention of health professionals in developing countries has important policy implications (1). In particular, improving the morale of health professionals appears to be achievable by adequate resources along with a service delivery infrastructure that is appropriate to the country and the specific health challenges it faces. <br><br>There are a number of factors that are of relevance to this agenda, including future disease projections which suggest that vascular disease will be the leading cause of death in developing countries in 2030 (2). Underpinning this, at least in part, is the rising prevalence of type 2 diabetes mellitus and obesity in developing countries (3). Furthermore, evidence suggests that in developing countries, some treatments may not be affordable and ways to increase availability, reduce prices and improve affordability of medicines is required (4).<br>Low-dose aspirin prophylaxis is inexpensive and reduces the risk of vascular disease so perhaps increased use of the medicine in developing countries could have far reaching benefits. Since the risk of vascular disease increases with age, low-dose aspirin prophylaxis might be beneficial once an individual becomes 50 years old (5). Furthermore, aspirin is also showing promise in cancer control (6) although the potential increased use of aspirin in the population does raise ethical issues, including risk of undesirable effects (7).<br>However, the appropriate use of low-dose aspirin could help save many lives in the increasingly ageing populations of developing countries (8). Furthermore, the potential reduction of the vascular disease burden in developing countries could help release valuable financial and human resources. Such resources could help develop service delivery infrastructures which would in turn improve the motivation and retention of health professionals. (December 15th 2008)<br>Gareth Morgan FRSPH, National Service Framework for Older People Project Manager, Welsh Assembly Government. Wales, UK. Email :<br>Dr Iskandar Idris DM FRCP (Lon) FRCP (Edin), Consultant Physician, <br>Sherwood Forest Hospital Foundation Trust, Nottinghamshire, England, UK.<br><br>Hon Senior Lecturer, University of Sheffield<br>Academic Unit of Diabetes, Endocrinology and Metabolism. Email:<br><br>References:<br>1. Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Improving motivation and retention of health professionals in developing countries : a systematic review. BMC Health Serv. Res. 2008;8(1):247.<br>2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e512.<br>3. Idris I, Deepa R, Fernando DJ, Mohan V. Relation between age and coronary heart disease (CHD) risk in Asian Indian patients with diabetes: A cross-sectional and prospective cohort study. Diabetes Res Clin Pract. 2008 Aug;81(2):243-9. Epub 2008 May 20. <br>4. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2008 Nov 28. [Epub ahead of print]<br>5. Bulugahapitiya U, Siyambalapitiya S, Sithole J, Fernando DJ, Idris I. Age threshold for vascular prophylaxis by aspirin in patients without diabetes. Heart. 2008 Nov;94(11):1429-32.<br>6. Morgan G.P. The potential contribution of aspirin to cancer control programmes. accessed on November 18th 2008. <br>7. Morgan G. ethical considerations in relation to aspirin prophylaxis. Quality in Primary Care 2008;16(6):433-440<br>8. Hennekens CH. Aspirin in the treatment and prevention of cardiovascular disease : current perspectives and future directions. Curr. Atheroscler. Rep. 2007;9(5):409-416.<br>

    Competing interests

    None declared

  2. A study from India that might have added to this systematic review

    11 November 2015

    Rajnish Joshi, All India Institute of Medical Sciences Bhopal

    I read with interest this article, which is insightful. However I will like to add on to the body of evidence on metrics of brain drain, an article published by Kaushik M and collegues in 2008 on Indian Physicians migrating to more developed countries. Contrary to conventional wisdom graduates from institutes that recieved more funds (hence a better quality medical training) had a greater liklihood of emigrating.

    (Ref Quality of Medical training and emigration of physicians from india, Health services research  BMC Health Services Research 2008, 8:279  doi:10.1186/1472-6963-8-279 (

    Thus metrics of Brain drain are complex, and may not have a direct relationship with facilities at home. Rather it is more of an attraction overseas that may have a greater impact. Poor infrastructure at home is an often cited justification, I presume. 


    Competing interests

    I have no competing interests

Authors’ Affiliations

Centre for Global Health, Trinity College Dublin, Dublin 2, Ireland
Women's Health Council, Block D, Irish Life Centre, Dublin 1, Ireland
Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa