IDENTIFYING POLICIES TO INCREASE THE SUPPLY OF HEALTH CARE WORKERS IN RURAL AREAS OF COLOMBIA

Colombia experiences persistent rural–urban imbalances in the distribution of its health workforce, with doctor and nurse supply below OECD averages and marked disparities across regions. These gaps particularly affect Afro-Colombian, Indigenous, and conflict-affected areas, where limited access to services contributes to preventable morbidity and mortality. Although international evidence identifies financial, non-financial, and systemic incentives that can support recruitment and retention in underserved regions, limited guidance exists on which strategies are most applicable to Colombia.This dissertation analyzes how to attract and retain healthcare workers in rural Colombia through a mixed-methods design that includes a systematic review, secondary data analysis, and surveys with healthcare workers in rural and urban areas, policymakers, academics, and professional associations. The study uses Herzberg’s Two-Factor Theory, Self-Determination Theory, the WHO Working Lifespan Approach, and the Push-Pull Framework to examine the factors that influence decisions to work and remain in rural areas. Findings indicate that financial incentives may facilitate initial recruitment, but long-term retention depends on improved working conditions, clear and structured rural career pathways, stronger rural training pipelines, adequate family and living supports, and governance mechanisms capable of sustaining policy continuity. Respondents from academic and professional bodies emphasized the need for alignment between education, professional education, and rural workforce needs.Based on these findings, the dissertation proposes a public policy plan to strengthen recruitment and retention of rural health workers. The plan includes strategies to stabilize employment, develop a defined rural career pathway, improve living and working conditions, align education and regulation with rural service requirements, and reinforce coordination among national, territorial, academic, and professional actors. By integrating individual, institutional, and system-level perspectives, this study provides an evidence-based and feasible roadmap to improve workforce distribution and expand access to essential healthcare in rural Colombia.