Factors favourable to career progression.

Absenteeism by doctors in public healthcare facilities in rural Bangladesh is a form of chronic rule-breaking and is recognised as a critical problem by the government. We explored the factors underlying this phenomenon from doctors’ perspectives. We conducted a facility-based cross-sectional survey in four government hospitals in Dhaka, Bangladesh. Junior doctors with experience in rural postings were interviewed to collect data on socio-demographic characteristics, work and living experience at the rural facilities, and associations with professional and social networks. Multiple logistic regression was used to determine the factors associated with rural retention. Of 308 respondents, 74% reported having served each term of their rural postings without interruptions. The main reasons for absenteeism reported by those who interrupted rural postings were formal training opportunities (65%), family commitments (41%), and a miscellaneous group of others (17%). Almost half of the respondents reported unmanageable workloads. Most (96%) faced challenges in their last rural posting, such as physically unsafe environments (70%), verbally abusive behaviour by patients/caregivers (67%) and absenteeism by colleagues that impacted them (48%). Respondents who did not serve their entire rural posting were less likely to report an unmanageable workload than respondents who did (AOR 0.39, 95% CI 0.22–0.70). Respondents with connections to influential people in the local community had a 2.4 times higher chance of serving in rural facilities without interruption than others (AOR 2.40, 95% CI 1.26–4.57). Our findings demonstrate that absenteeism is not universal and depends upon doctors’ socio-political networks. Policy interventions rarely target unsupportive or threatening behaviour by caregivers and community members, a pivotal disincentive to doctors’ willingness to work in underserved rural areas. Policy responses must promote opportunities for doctors with weak networks who are willing to attend work with appropriate support.

孟加拉国农村公立医疗机构中医师缺勤属于长期违规行为，已被该国政府认定为亟待解决的严峻问题。本研究从医师视角出发，探究该现象背后的成因。研究团队在孟加拉国达卡的四家公立医院开展了基于机构的横断面调查，对有农村岗位任职经历的初级医师进行访谈，收集其社会人口学特征、农村医疗机构的工作与生活经历，以及与职业和社会网络关联的相关数据。研究采用多因素logistic回归分析，明确与农村岗位留任相关的影响因素。在308名受访医师中，74%表示其农村岗位任职周期均未中断。那些中断农村岗位任职的受访者报告的缺勤主要原因包括：正式培训机会（65%）、家庭事务（41%），以及其他杂项原因（17%）。近半数受访者表示工作负荷难以承受。绝大多数（96%）受访者在最后一次农村岗位任职期间遭遇了各类挑战：包括物理环境不安全（70%）、患者/陪护人员的言语辱骂（67%），以及影响自身工作的同事缺勤情况（48%）。未完成全部农村岗位任职的受访者，报告工作负荷难以承受的可能性低于完成任职的受访者（调整后优势比[AOR] 0.39，95%置信区间[CI] 0.22–0.70）。与当地社区有影响力人士存在关联的受访者，能够无中断地完成农村岗位任职的概率是其他受访者的2.4倍（AOR 2.40，95% CI 1.26–4.57）。本研究结果表明，医师缺勤并非普遍现象，其发生与医师的社会政治网络密切相关。当前的政策干预几乎未针对陪护人员与社区成员的不友善或威胁性行为，而这类行为正是阻碍医师愿意在医疗资源匮乏的农村地区工作的关键阻碍因素。政策制定者应通过适当支持，为社会关系薄弱且愿意在岗履职的医师提供更多发展机会。