For more than money: willingness of health professionals to stay in remote Senegal

Abstract

Background Poor distribution of already inadequate numbers of health professionals seriously constrains equitable access to health services in low- and middle-income countries. The Senegalese Government is currently developing policy to encourage health professionals to remain in areas defined as ‘difficult’. Understanding health professional’s preferences is crucial for this policy development. Methods Working with the Senegalese Government, a choice experiment (CE) was developed to elicit the job preferences of physicians and non-physicians. Attributes were defined using a novel mixed-methods approach, combining interviews and best-worst scaling (Case 1). Six attributes were categorised as ‘individual (extrinsic) incentive’ attributes (‘type of contract’, ‘provision of training opportunities’, ‘provision of an allowance’ and ‘provision of accommodation’) or ‘functioning health system’ attributes (‘availability of basic equipment in health facilities’ and ‘provision of supportive supervision by health administrators’). Using face-to-face interviews, the CE was administered to 55 physicians (3909 observations) and 246 non-physicians (17 961 observations) randomly selected from those working in eight ‘difficult’ regions in Senegal. Conditional logit was used to analyse responses. This is the first CE to both explore the impact of contract type on rural retention and to estimate value of attributes in terms of willingness to stay (WTS) in current rural post. Results For both physicians and non-physicians, a permanent contract is the most important determinant of rural job retention, followed by availability of equipment and provision of training opportunities. Retention probabilities suggest that policy reform affecting only a single attribute is unlikely to encourage health professionals to remain in ‘difficult’ regions. The relative importance of an allowance is low; however, the level of such financial incentives requires further investigation. Conclusion Contract type is a key factor impacting on retention. This has led the Senegalese Health Ministry to introduce a new rural assignment policy that recruits permanent staff from the pool of annually contracted healthcare professionals on the condition that they take up rural posts. While this is a useful policy development, further efforts to retain rural health workers, considering both personal incentives and the functioning of health systems, are necessary to ensure health worker numbers are adequate to meet the needs of rural communities.

Job preferences for medical and nursing students to work in rural Guizhou Province, China: a discrete choice experiment

“…Unlike several studies showing that financial incentives were not found to be most powerful policy levers [13,26,28,31,33,36,38,44]. However, our findings conformed that monthly income had a significant impact on the job choices of undergraduate health students, similar with other studies [10,37,45].…”

“…This is particularly true for medical and nursing students, who are often disappointed by the gap between what they have been taught to do, often based in a tertiary hospital infrastructure, and the availability of equipment in rural health facilities where they are expected to work after the graduation. These results are consistent with those from other DCEs [13,35,37,38,41]. Also, a review paper on health worker's motivation and retention indicates that the improvement of hospital infrastructure and resource available could increase retention [42].…”

“…Recently, the use of mixed logit models is increasing [1,10,15,26,[30][31][32][33][34][35][36][37][38] which take the preference heterogeneity among respondents into consideration. The underpinning of discrete choice model is random utility theory, stipulating that respondents as a rational economic individual consider all the relevant information and choose the option that can maximize the utility.…”

Factors associated with self-rated health among mineworkers in Zambia: a cross-sectional study

“…29 A study from Senegal reported that the provision of a permanent contract was the most important factor for retaining employees in rural and challenging regions, following the availability of necessary equipment in working facilities and the provision of training opportunities. 30 In the mining industries, the situation may be similar. The satisfaction of temporal nancial needs as well as comfortable working environments/conditions, including a balanced and proper salary and guaranteed sustainability of these working conditions, should be fundamental for both individual workers and organizations.…”

Distribution Analysis of Doctors in Indonesia

“…The capitation system that is used as the basis for payment of medical services is difficult for doctors who work in remote areas, especially with diffuse geographical and demographic conditions. A difficult work environment and does not guarantee social life is also a separate obstacle (Laksono, Nantabah and Wulandari, 2018;Bertone, Lurton and Mutombo, 2016;Honda et al, 2019;Mashange et al, 2019).…”