iHRIS Retain: A New Tool Estimates the Cost of Making Rural Practice More Attractive to Health Workers

IntraHealth International announces the release of iHRIS Retain, a freely available and open source software tool that estimates the costs of plans to attract health workers to serve in a rural region—and to keep them there. The tool allows health sector officials to easily compare the costs of various combinations of retention strategies over time.

Although nearly half of the world’s population lives in rural areas, less than 38% of the world’s nurses and a quarter of the world’s doctors work in those areas.1 Health workers serving in rural areas are often making substantial professional and personal compromises. Working and living conditions and the quality of infrastructure and other social services can be challenging in rural and remote communities. Health workers may have to care for patients with no running water available, experience professional isolation, and accept poorer educational opportunities for their children.

iHRIS (pronounced “iris”) Retain builds on the World Health Organization’s (WHO’s) 2010 global policy recommendations, which describe ways to retain more health workers in rural and remote areas by combining strategies related to education, financial incentives, regulation, and professional development. There is no one-size-fits-all solution. The WHO recommends offering packages of incentives that are targeted to specific types of health workers. In addition to determining strategies that will work, health sector managers also need to find those strategies they can afford. But determining the costs of these packages over time is not simple.

IntraHealth’s global CapacityPlus project (funded by USAID) and the WHO worked together to create iHRIS Retain to estimate the costs of retention strategies at the district, regional, or national levels. The open source software guides users step by step through the process to capture relevant financial and health workforce data. iHRIS Retain then calculates the total costs—generating reports for each retention strategy and type of health worker, as well as for different packages of strategies—and compares the costs to available funding. Country health leaders can use the information to determine which retention strategies are feasible and then calculate their budgets for enacting them.

Previously, similar cost-estimating exercises in developing countries have often depended on technical assistance from international health economists. But iHRIS Retain is specifically designed for human resources managers and other health officials. It reduces reliance on international technical assistance and empowers health workforce stakeholders to select and carry out affordable retention strategies.

iHRIS Retain is the newest addition to the iHRIS platform of health workforce tools and technologies. The forthcoming Rapid Retention Survey Toolkit will help countries develop the most attractive retention packages, which can then be costed using iHRIS Retain. Both tools were field-tested in Lao People’s Democratic Republic, where more than 80% of people live in rural areas.


Toward Development of a Rural Retention Strategy in Lao People’s Democratic Republic: Understanding Health Worker Preferences
This report presents the results of ... Read More »

iHRIS: Tracking over 475,000 Health Workers Worldwide
The world needs approximately 4.3 million additional health workers. Africa alone needs 1.4 million more. Having the right number of health workers, however, is not enough. How can ... Read More »

1. World Health Organization. 2010. Global policy recommendations: Increasing access to health workers in remote and rural areas through improved retention. Geneva, Switzerland: World Health Organization.