Suriname faces challenges retaining health workers in remote, rural areas with sparse populations and lack of infrastructure and opportunities. To address this, strategies include compulsory work periods, collective employment contracts, infrastructure improvements, and incentives like allowances. The main training institutions are regulated to provide workers for remote areas. However, more can be done to acknowledge and recognize these important health workers through awards, incentives for research, and knowledge exchange.

1. SURINAME
STRATEGIES TO RETAIN HEALTH WORKERS IN REMOTE,
UNDERSERVED AREAS

2. Suriname can be divided in
 Rural Interior
 Rural coastal
 Urban (coastal)

3. PROVISION OF PRIMARY HEALTH CARE IN
SURINAME
In Suriname, we can distinguish three geographic
areas in the provision of Primary Health Care:
 Urban (coastal) provided by either the Regional
Health Services or Private General
Practitioners
 Rural coastal provided by the Regional Health
Services
 Rural Interior provided by the Medical Mission
PHCS
Our presentation is focusing on both rural areas.

5. Remote areas National
(population
of 500.000)
Rural coastal
area, RGD
(population of
200.000)
Rural interior
area, MZPHCS
(population of
48.179)¹
Number of physicians/1000
inhabitants
0.3 0.15 0.45
number of nurses/1000
inhabitants
1.0 2.16² 1.62
number of dentists/1000
inhabitants
0 0 0.01
number of health
promoters/health agents/1000
inhabitants
0.02 0.04 < 1
[1] Data of 2012
[2] Health assistants
Distribution of health workers

6. PROBLEMS IN THE PLACEMENT OF HEALTH
WORKERS
Factors for non‐placement of workers in areas with
fewer workers
 Sparely populated areas and isolation from lager
society
 Poor infrastructure (houses, etc.)
 The lack of:
 utilities such as permanent electricity, running water,
sanitation and modern communication;
 employment and other opportunities for spouses and
secondary and tertiary schools for children;
 diverse social contacts;
 opportunities to continued study.

7. TYPE OF HEALTHWORKERS
Difficult to place in remote and underserved areas are:
 Nurses, specialist nurses (HIV-, DM-, schoolnurses,
etc.), midwifes;
 Physicians;
 Dentists and dental care providers;
 Pharmacists and assistant pharmacists;
 Paramedical personnel such as physiotherapists, etc.;
 Health educators.

8. FORMS OF CONTRACTING AND REMUNERATION
FOR THE HEALTH WORKFORCE IN THE PUBLIC
SECTOR
 contracting workers
 Monthly salary paid workers
 Employers are employed by a:
 Faith based foundation subsidized by the national
government (Medical Mission).
 State owned foundation subsidized by the national
government (Regional Health Service).
 professionals’ remuneration types
 Monthly salaries with performance bonuses once a year.

9. Rural coastal
provided by the Regional Health Services
Rural Interior
provided by the Medical Mission PHCS
Students (nursing, pharmacy-assistants, midwife-
students, etc.) are hired out of the rural districts
for the specific studies under a contract.
The contract include the fact that the organization
gives a scholarship, but students has the
compulsory internships and after finishing they
have to work in the remote area for at least 3
years
Minimum of 4 years compulsory work
period in the hinterland for all health
assistants who are trained by the Medical
Mission and are viewed as the central
health care worker for the hinterland
population.
Note:
For the rural interior we try to overcome the global and national crisis of shortage on healthworkers partly by making use of Health assistants.
Health assistants are not Community Health Workers. They can be comparing with a physician assistant (USA) who is a healthcare professional
licensed to practice medicine as part of a team with physicians. They are concerned with preventing and treating human illness and injury by
providing a broad range of health care services under the direction of a physician. They conduct physical exams, diagnose and treat illnesses,
order and interpret tests, prescribe medications, conduct childbirth and counsel on preventive health care.
Placement strategies for workers in remote and
underserved areas
Compulsory working period

10. Rural coastal
provided by the Regional Health Services
Rural Interior
provided by the Medical Mission PHCS
Conditions in a collective contract of employment makes relocation to other remote areas
possible for all health workers working with the Regional Health Services or the Medical
Mission PHCS.
Workers in Rural coastal areas has special
remuneration such as “residence -allowance”,
transportation payment, etc.
Health assistants receive a residence -
allowance upon their salary depending on
the degree of isolation of the place they
have to work.
The institute’s HR department is responsible for the elaboration and execution, and the
government is responsible for the financing by subsidizing the institution.
Placement strategies for workers in remote and
underserved areas
Collective employment contract

11. Rural coastal
provided by the Regional Health Services
Rural Interior
provided by the Medical Mission PHCS
The strategies includes enhancement of
the work environment
Some of the interventions are:
 renovation of facilities
 introduce ICT in health work
 improved medicine supply
 multidisciplinary approach of health
work by integrating social workers ,
spiritual guides etc
As much as possible facilities are put in
place for pleasant residency in the interior.
 Free housing near the health facilities
 Make solar energy systems and running
water available
 cellular phones and tablets with
internet connection are available on
many remote health centers and clinics.
Placement strategies for workers in remote and
underserved areas
Improvement of infrastructure

12. REGULATING THE AVAILABILITY OF HEALTH
WORKERS
The main training institutions producing PHC workers are:
 The Central School for nursing and auxiliary healthcare
workers in the capital (trains mostly for hospitals)
 The training program of the Medical Mission for Health
Assistants for the Hinterland
 The Medical Faculty
 Uptake of medical students have been increased
 Students who receive scholarships are required to work a
number of years in remote areas. However this requirement is
not any longer followed strictly

13. STRATEGIES OF SOCIAL ACKNOWLEDGEMENT AND
RECOGNITION OF HEALTH WORKERS IN THE PHC
 Social acknowledgement and recognition is not well
developed. A few general acknowledgements such
as:
 “nurse of the year” award.
 “best health worker for the interior”.
 There are no incentives for research and
knowledge exchange for these professionals.
 The national strategic plan for the renewal of PHC
has identified the development of an incentives
system for working in PHC as a priority.