Rural practice preferences among medical students in Ghana: a discrete choice experiment

Kruk, Margaret E; Johnson, Jennifer; Gyakobo, Mawuli; Agyei‐Baffour, Peter; Asabir, Kwesi; Kotha, S Rani; Kwansah, Janet; Nakua, Emmanuel Kweku; Snow, Rachel; Dzodzomenyo, Mawuli

doi:10.2471/blt.09.072892

Cited by 135 publications

(191 citation statements)

References 15 publications

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“…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).…”

Section: Health Facility Infrastructuresupporting

confidence: 82%

“…The majority of DCEs examine job preferences of specific cadres of health workers such as nurses (21), nursing students (22), medical students (20) or medical students and doctors (7). Our study looks at job preferences of a variety of cadres represented in the national health system.…”

Section: Discussionmentioning

confidence: 99%

“…These models allow for heterogeneity in preferences and also enable one to model repeated choices made by the same individual. They overcome a number of the restrictions of, and are therefore an improvement over models such as the conditional logit (22). All statistical analysis was done using Stata 11.…”

Section: Attribute Level Descriptionmentioning

confidence: 99%

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

Robyn

Shroff

Zang

et al. 2015

Int J Health Policy Manag

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Background: Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH) is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas. Methods: To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE) was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data. Results: Among medical and nursing students a rural retention bonus of 75% of base salary (aOR= 8.27, 95% CI: 5.28-12.96, P< 0.001) and improved health facility infrastructure (aOR= 3.54, 95% CI: 2.73-4.58) respectively were the attributes with the largest effect sizes. Among medical doctors and nurse aides, a rural retention bonus of 75% of base salary was the attribute with the largest effect size (medical doctors aOR= 5.60, 95% CI: 4.12-7.61, P< 0.001; nurse aides aOR= 4.29, 95% CI: 3.11-5.93, P< 0.001). On the other hand, improved health facility infrastructure (aOR= 3.56, 95% CI: 2.75-4.60, P< 0.001), was the attribute with the largest effect size among the state registered nurses surveyed. Willingness-to-Pay (WTP) estimates were generated for each health worker cadre for all the attributes. Preference impact measurements were also estimated to identify combination of incentives that health workers would find most attractive. Conclusion: Based on these findings, the study recommends the introduction of a system of substantial monetary bonuses for rural service along with ensuring adequate and functional equipment and uninterrupted supplies. By focusing on the analysis of locally relevant, actionable incentives, generated through the involvement of policymakers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health. Implications for policy makers• Based on a Discrete Choice Experiment (DCE) analyzed using mixed logit and Willingness-to-Pay (WTP) analysis, we recommend substantial monetary bonuses for rural service along with ensuring supplies and equipment for at least a basic package of health services to motivate health workers • Classification of posts based on remoteness and tying level of bonuses to this may be necessary to attract health workers to the most rural areas • Offering specialist training and housing, as proposed by the Ministry of Public Health (MoPH) were less popular incentives across health worker cadres examined • Focusing on actionable incentives and conducting locally relevant research are vital if findings are to influence policy-making Implications for publicAttracting and retaining qu...

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Section: Health Facility Infrastructuresupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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

Robyn

Shroff

Zang

et al. 2015

Int J Health Policy Manag

View full text Add to dashboard Cite

show abstract

“…Recent studies have highlighted the importance of providing an appropriate salary to attract health workers to underserved areas (Bärnighausen and Bloom 2009;McCoy et al 2008;Rockers et al 2012;Willis-Shattuck et al 2008). Salary, however, is only one of many factors that health workers consider when making choices about where to work Dambisya 2007;Kruk et al 2010;Rockers et al 2013). A discrete choice experiment (DCE) can assist in identifying health workers' motivational preferences and determining appropriate incentive packages that will attract and retain health workers in rural and underserved areas.…”

Section: Health Workers' Perceptions Of Compensation Levelsmentioning

confidence: 99%

Analyzing the Determinants of Health Worker Performance

Leonard¹,

Mæstad²

2016

Health Labor Market Analyses in Low- And Middle-Income Countries: An Evidence-Based Approach

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“…Sub-Saharan Africa has the lowest density of health professionals per capita of any region (Kruk et al, 2010), despite having the highest burden of disease (Anyangwe & Mtonga, 2007;Van Rensburg, 2014). At the same time, the demand for health care is rising as many countries deal with…”

Section: Introductionmentioning

confidence: 99%

Factors influencing recruitment and retention of professional nurses, doctors and allied health professionals in rural hospitals in KwaZulu Natal

Haskins

Phakathi

Grant

et al. 2017

Health SA Gesondheid

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Introduction: In South Africa fewer health professionals (HPs) work in rural areas compared to urban areas, despite rural communities having greater health needs. This study explores factors influencing recruitment and retention of three categories of HPs in KwaZulu-Natal and has implications about how to retain them in rural areas.Methods: A cross-sectional, descriptive survey was conducted in 8 hospitals, 5 rural and 3 urban, in one district in KZN in 2011. Data were collected on single day in each hospital and all HPs on duty were requested to participate. We compared responses from rural and urban based HP as well as professional nurses (PNs), doctors, and allied HPs.Results: 417 questionnaires were completed: 150 from HPs in rural and 267 from HPs in urban hospitals. Perceptions of living/working in rural areas is negative and the quality of health care provided in rural areas is perceived as poor by all categories of HP. Rural-basedHPs were more likely to report living apart from spouse/partner (72.1% vs 37.0%, p < 0.001)and children (76.7% vs 36.9%, p < 0.001), and living in hospital accommodation (50.8% vs 28.9%; p < 0.001).Conclusions: Decisions made by HP about where to work are complex, multifactorial and should be tailored to each category of health professional.

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Rural practice preferences among medical students in Ghana: a discrete choice experiment

Cited by 135 publications

References 15 publications

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

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

Analyzing the Determinants of Health Worker Performance

Factors influencing recruitment and retention of professional nurses, doctors and allied health professionals in rural hospitals in KwaZulu Natal

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