SURINAME STRATEGIES TO RETAIN HEALTH WORKERS IN REMOTE, UNDERSERVED AREAS

Suriname can be divided in

Rural Interior

Rural coastal

Urban (coastal)

PROVISION OF PRIMARY HEALTH CARE IN

SURINAME

In Suriname, we can distinguish three geographic areas in the provision of Primary Health Care:

Urban (coastal) provided by either the Regional Health Services or Private General Practitioners

Rural coastal provided by the Regional Health Services

Rural Interior provided by the Medical Mission PHCS

Our presentation is focusing on both rural areas.

Remote areas National

(population

of 500.000) Rural coastal

area, RGD

(population of

200.000)

Rural interior

area, MZPHCS

(population of

48.179)¹

Number of physicians/1000

inhabitants

0.3 0.15 0.45

number of nurses/1000

inhabitants

1.0 2.16²

1.62

number of dentists/1000

inhabitants

0 0 0.01

number of health

promoters/health agents/1000

inhabitants

0.02 0.04 < 1

[1] Data of 2012 [2] Health assistants

Distribution of health workers

PROBLEMS IN THE PLACEMENT OF HEALTH

WORKERS

Factors for non‐placement of workers in areas with

fewer workers

Sparely populated areas and isolation from lager

society

Poor infrastructure (houses, etc.)

The lack of:

utilities such as permanent electricity, running water,

sanitation and modern communication;

employment and other opportunities for spouses and

secondary and tertiary schools for children;

diverse social contacts;

opportunities to continued study.

TYPE OF HEALTHWORKERS

Difficult to place in remote and underserved areas are:

Nurses, specialist nurses (HIV-, DM-, schoolnurses,

etc.), midwifes;

Physicians;

Dentists and dental care providers;

Pharmacists and assistant pharmacists;

Paramedical personnel such as physiotherapists, etc.;

Health educators.

FORMS OF CONTRACTING AND REMUNERATION

FOR THE HEALTH WORKFORCE IN THE PUBLIC

SECTOR

contracting workers

Monthly salary paid workers

Employers are employed by a:

Faith based foundation subsidized by the national

government (Medical Mission).

State owned foundation subsidized by the national

government (Regional Health Service).

professionals’ remuneration types

Monthly salaries with performance bonuses once a year.

Rural coastal

provided by the Regional Health Services

Rural Interior

provided by the Medical Mission PHCS

Students (nursing, pharmacy-assistants, midwife-students, etc.) are hired out of the rural districts for the specific studies under a contract.

The contract include the fact that the organization

gives a scholarship, but students has the

compulsory internships and after finishing they

have to work in the remote area for at least 3

years

Minimum of 4 years compulsory work period in the hinterland for all health assistants who are trained by the Medical Mission and are viewed as the central health care worker for the hinterland population.

Note: For the rural interior we try to overcome the global and national crisis of shortage on healthworkers partly by making use of Health assistants. Health assistants are not Community Health Workers. They can be comparing with a physician assistant (USA) who is a healthcare professional licensed to practice medicine as part of a team with physicians. They are concerned with preventing and treating human illness and injury by providing a broad range of health care services under the direction of a physician. They conduct physical exams, diagnose and treat illnesses, order and interpret tests, prescribe medications, conduct childbirth and counsel on preventive health care.

Placement strategies for workers in remote and underserved areas

Compulsory working period

Rural coastal

provided by the Regional Health Services

Rural Interior

provided by the Medical Mission PHCS

Conditions in a collective contract of employment makes relocation to other remote areas possible for all health workers working with the Regional Health Services or the Medical Mission PHCS.

Workers in Rural coastal areas has special remuneration such as “residence -allowance”, transportation payment, etc.

Health assistants receive a residence -

allowance upon their salary depending on

the degree of isolation of the place they

have to work.

The institute’s HR department is responsible for the elaboration and execution, and the government is responsible for the financing by subsidizing the institution.

Placement strategies for workers in remote and underserved areas

Collective employment contract

Rural coastal

provided by the Regional Health Services

Rural Interior

provided by the Medical Mission PHCS

The strategies includes enhancement of the work environment Some of the interventions are:

renovation of facilities

introduce ICT in health work

improved medicine supply

multidisciplinary approach of health

work by integrating social workers ,

spiritual guides etc

As much as possible facilities are put in

place for pleasant residency in the interior.

Free housing near the health facilities

Make solar energy systems and running

water available

cellular phones and tablets with

internet connection are available on

many remote health centers and clinics.

Placement strategies for workers in remote and underserved areas

Improvement of infrastructure

REGULATING THE AVAILABILITY OF HEALTH

WORKERS

The main training institutions producing PHC workers are:

The Central School for nursing and auxiliary healthcare

workers in the capital (trains mostly for hospitals)

The training program of the Medical Mission for Health

Assistants for the Hinterland

The Medical Faculty

Uptake of medical students have been increased

Students who receive scholarships are required to work a

number of years in remote areas. However this requirement is

not any longer followed strictly

STRATEGIES OF SOCIAL ACKNOWLEDGEMENT AND

RECOGNITION OF HEALTH WORKERS IN THE PHC

Social acknowledgement and recognition is not well developed. A few general acknowledgements such as:

“nurse of the year” award.

“best health worker for the interior”.

There are no incentives for research and knowledge exchange for these professionals.

The national strategic plan for the renewal of PHC has identified the development of an incentives system for working in PHC as a priority.