Inequitable distribution of human resources for health: perceptions among Thai healthcare professionals.

BACKGROUND Effective delivery of health care is dependent on health manpower. In Thailand, an insufficiency of human resources relates to an inequitable distribution of healthcare professionals rather than to insufficiencies overall. Both internal and external factors influence healthcare professionals' choice of where to work, although perceptions rather than actual circumstances are more influential in their decision-making process. This inequitable distribution of healthcare professionals in Thailand affects rural areas and the provision of primary health care. OBJECTIVES To understand the subjective perceptions, attitudes and dynamics among healthcare professionals regarding where they seek employment and the impact on the provision of primary care. DESIGN Questionnaire survey among Thai healthcare students and professionals and semi-structured interviews with healthcare professionals investigating attitudes and perceptions. SETTING Thai rural, urban and metropolitan areas. RESULTS An interesting mix of factors influences healthcare professionals with regard to where they seek employment, or continue their employment. Family and community commitments, social status and a sense of belonging were associated with healthcare professionals seeking employment in their province of origin. Tensions are also emerging between preventative and curative health. These tensions, together with financial remuneration and professional development opportunities and promotions, as perceived by healthcare professionals themselves, have implications for current and future healthcare policy. CONCLUSION The scaling up of human resources for health in Thailand will not, based on past experiences and attitudes outlined in this research, ensure an equitable distribution of healthcare professionals. Further consideration of these professionals' expectations of being able to work in areas close to their families and of sufficient financial remuneration is required. It is likely that rural regions and the delivery of primary care will be negatively affected by continued inequities. It was also found that current healthcare policies are creating new tensions.