Factors affecting the retention of Indigenous Australians in the health workforce: a systematic review

Background: Indigenous Australians are under-represented in the health workforce. The shortfall in the Indigenous health workforce compounds the health disparities experienced by Indigenous Australians, and in addition, results in pressure on health professionals who are Indigenous. This systematic review aims to identify enablers and barriers to the retention of Indigenous Australians within the health workforce and to describe strategies to assist with development and retention of Indigenous health professionals.
Methods: For this systematic review of the literature, four electronic databases were searched for peer-reviewed articles that discussed factors that support or inhibit retention of Indigenous Australians in the health workforce and related recommendations. In addition, relevant grey literature was identified through citation snowballing and careful review of relevant websites, including Indigenous health professional organisations. Articles were screened for inclusion using pre-defined criteria and assessed for quality using the Mixed Methods Assessment Tool. Findings were analysed and grouped into the following categories: (1) structural factors, (2) health and education system factors, (3) organisational factors, and (4) individual level factors.
Results: Fifteen articles met criteria for inclusion. Important factors affecting the retention of Indigenous health professionals included: work environment (including the attitude of health leaders and co-workers, access to supervision, mentoring and training, opportunities for career advancement); heavy workloads; vague or poorly documented/understood roles and responsibilities; low salary and a perception of salary disparity; and the influence of community as both a strong personal motivator and source of stress when work/life boundaries could not be maintained.
Conclusion: Evidence suggests that retention of Indigenous health professionals will be improved through building supportive and culturally safe workplaces; clearly documenting and communicating roles, scopes of practice and responsibilities; and ensuring that employees are appropriately supported and remunerated. Health services and individual workplaces often have policies and statements that endorse closing the gap in Indigenous health disparities and around Indigenous employment. However, they need to move beyond rhetoric to committed implementation of strategies that improve retention of Indigenous health professionals. These strategies should be formally and collaboratively designed, documented, implemented, evaluated and reported in order to build evidence regarding which retention strategies are most effective. The absence of intervention studies highlights the need for deliberative interventions which rigorously evaluate all aspects of implementation of relevant workforce, health service policy and practice change.