Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment

Abstract

BackgroundHealth facilities require teams of health workers with complementary skills and responsibilities to efficiently provide quality care. In low-income countries, failure to attract and retain health workers in rural areas reduces population access to health services and undermines facility performance, resulting in poor health outcomes. It is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas.MethodsWe investigated preferences for job characteristics among final year medical, nursing, pharmacy, and laboratory students at select universities in Uganda. Participants were administered a cadre-specific discrete choice experiment that elicited preferences for attributes of potential job postings they were likely to pursue after graduation. Job attributes included salary, facility quality, housing, length of commitment, manager support, training tuition, and dual practice opportunities. Mixed logit models were used to estimate stated preferences for these attributes.ResultsData were collected from 246 medical students, 132 nursing students, 50 pharmacy students and 57 laboratory students. For all student-groups, choice of job posting was strongly influenced by salary, facility quality and manager support, relative to other attributes. For medical and laboratory students, tuition support for future training was also important, while pharmacy students valued opportunities for dual practice.ConclusionsIn Uganda, financial and non-financial incentives may be effective in attracting health workers to underserved areas. Our findings contribute to mounting evidence that salary is not the only important factor health workers consider when deciding where to work. Better quality facilities and supportive managers were important to all students. Similarities in preferences for these factors suggest that team-based, facility-level strategies for attracting health workers may be appropriate. Improving facility quality and training managers to be more supportive of facility staff may be particularly cost-effective, as investments are borne once while benefits accrue to a range of health workers at the facility.

Addressing health workforce distribution concerns: a discrete choice experiment to develop rural retention strategies in Cameroon

“…This is particularly true for medical students, who are often disappointed by the gap between what they have been trained to do, often based in a tertiary hospital environment, and the availability of drugs and equipment in rural health facilities where they are expected to work upon completing their studies. These results are consistent with those from other DCEs in Sub-Saharan Africa (22,23).…”

“…While DCEs suffer from limitations such as making providers choose between two hypothetical options and reflecting stated preferences as opposed to actual behavior (23), this study contributes significantly to the building a policy dialogue based on evidence, which remains a challenge in Cameroon where there remains a significant gap in health systems research, particularly for human resources for health. Based on the findings of this study, health workforce retention policies should include a combination of both monetary and non-financial incentives.…”

Job Preferences of Doctors for Working in Rural Islamabad Capital Territory, Pakistan: a Discrete Choice Experiment

“…It is recommended to carry out context focused analytical work, such as Discrete Choice Experiment so that the incentive packages are better calibrated and customized. It is evident from other studies that preferences of health workforce varies significantly through countries and within countries, depending on the characteristics of individuals of that cadre [20][21][22]. The results of this study provided an important insight into the priority job attributes that can be utilized for rural recruitment and retention policies for doctors in Islamabad Capital Territory, as well as for the design of future Discrete Choice Experiments in Pakistan.…”

“…Job and financial security are major concerns behind job satisfaction [31,32]. Transportation did not show significant results.…”

“…The list of attributes that were used for the design of DCE were in line with WHO list of incentives [19] as well as other studies on DCE like in Tanzania [14], Uganda [20] and Cameroon [21] where similar attributes were given priority by medical students and fresh doctors [20].…”