Retention of general practitioners in rural Nepal: a qualitative study

Objectives:  To explore the key issues that influence GP retention in rural areas of Nepal.
Design:  A qualitative study using triangulation of data from one postal questionnaire, one hand-delivered questionnaire with semistructured interview and focus group discussions. Data from a small community survey from 13 rural districts also included.
Participants:  Sixty-two Nepali GPs, 25 doctors in General Practice training programs, 11 individuals involved in policy development and rural health care.
Results:  The key issues identified by this study as critical to the retention of Nepali GPs in rural areas were:
•  Career/promotion prospects
•  Status/recognition
•  Financial incentives
•  Working conditions
•  Education for children
•  Continuing medical education
•  Political stability and security
Conclusions:  The strongest theme was that of career development. This must be addressed by the Government of Nepal if there is to be any hope of improving retention of GPs in rural areas. GPs need to have a clear career ladder, with recognition of the value of service in rural areas. There is, however, no one single answer to the complex interacting factors that impact on GP retention in rural Nepal. A multifaceted, holistic response is necessary. From the level of community awareness, a career structure and financial remuneration to adequately set up hospitals, functional teams, family support, continuing professional development and a secure working environment – each area must be addressed for the whole to function.