How to recruit and retain health workers in underserved areas: the Senegalese experience.

PROBLEM Significant regional disparities in human resources for health deployment in Senegal weaken the country's health system and compromise population health. APPROACH In recent years, the Ministry of Health adopted measures to improve the posting, recruitment and retention of health workers in rural and remote areas. One was the introduction of a special contracting system to recruit health workers. LOCAL SETTING Health workers in Senegal are concentrated in specific urban centres, particularly Dakar. Whereas the Dakar region has 0.2 physicians per 1000 population, the Fatick, Kaolack, Kolda and Matam regions have fewer than 0.04. The density of midwives and, to a lesser extent, of nurses also varies considerably among different regions in Senegal. RELEVANT CHANGES Between 2006 and 2008, the introduction of the special contracting system contributed to the successful recruitment of health workers in remote and rural regions and the reopening of health outposts. LESSONS LEARNT The introduction of a special contracting system for health workers was a successful approach to reopening health posts in regions with low health workforce density in Senegal. However, the long-term sustainability of such an approach, particularly in fiscal terms, must be considered, as a single policy intervention may not be enough to address the diverse and complex challenges in human resources for health facing different regions of Senegal.