A roadmap out of medical deserts into supportive health workforce initiatives and policies, results from the ROUTE-HWF study

BACKGROUND: Medical deserts are coined as a specific term for areas dealing with low levels of health workers and health services. Health-underserved areas are a Europe wide problem, but still there is a lack of understanding on the different types and causes of medical ‘desertification’. In absence of a clear definition and categorization, countries acknowledge the severity of medical desert problems and take action. But they do so without taking opportunities to learn from each other, in terms of finding the rationale underlying the appropriate choice of policies and measures. AIMS AND OBJECTIVES: The aim of the ROUTE-HWF project that will be presented is to develop an elaborated taxonomy on medical deserts that supports country comparison, and improves the matching of different policy initiatives with different types of medical deserts. This includes guidelines on how to monitor and measure medical deserts, and solutions like task shifting and retention of health workers. METHODS: The ROUTE-HWF project is based on a systematic literature review, a survey among European countries, and workshops with case studies among a selected number of countries. During each stage of the project the taxonomy and a roadmap ‘out of medical deserts’ is further developed. RESULTS: We present the ROUTE-HWF taxonomy and roadmap with guidelines for monitoring and measuring medical deserts. Three main distinctive types of medical deserts are defined: medical deserts mainly caused by problems with the accessibility of health workers and facilities, medical deserts mainly caused by problems with population needs in area, and medical deserts with (cumulation) of problems both at the demand and supply side of the local health system. We show that this categorization is useful to tailor health policy measures to the distinctive causes and solutions for medical deserts, enabling mutual or cluster country learning within Europe.