Monday, April 27, 2020

A mandatory bonding service program and its effects on the perspectives of young doctors in Nepal

Introduction: To address regional differences in the distribution of health workers between rural and urban areas, the Nepal government has adopted the policy of deploying fresh medical graduates to remote areas for 2 years under a compulsory bonding service program. However, the impact of such an approach of redistribution of human resources for health is not well understood, nor is the experience of the health workers who are deployed. This study aimed to understand the experience of the medical graduates who have served under the bonding service program and suggest ways to improve the program as well as to make health service provision easier through the young doctors. Methods: A semi-structured questionnaire-based survey was administered online to 69 young medical doctors who had worked under the bonding service program. The responses were analysed qualitatively and the findings were presented in separate pre-established domains. Results: Most young doctors felt they were not adequately prepared for the bonding service program. Adapting to the deployed place and to the local culture was a challenge to some young doctors, which hindered their potential to serve the local community. Most found the response from the rural communities to be positive even though they faced some challenges in the beginning. While the young doctors found serving the rural communities motivating, they felt that they were limited in their capacity to provide an optimal level of health service due to limitations of infrastructure and medical equipment. They also felt that the compulsory bonding program had stunted their growth potential as medical doctors without adequately compensating them for their time and service. Conclusion: Despite the program's noble intentions, the medical doctors who were involved with the bonding service program felt that the program had yet to address several basic needs of the doctors who were deployed for service provision. In order to motivate the doctors to work in rural areas in future after the compulsory binding has ended, the stakeholders need to address the existing gaps in policies and infrastructure.

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