Stated Preferences of Doctors for Choosing a Job in Rural Areas of Peru: A Discrete Choice Experiment

Abstract

BackgroundDoctors’ scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors’ stated preferences for rural jobs.Methods and FindingsA labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho’s capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%.ConclusionsDoctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden.

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

“…Assuming the current rate of retention and attraction of doctors to work in rural settings to be 50%, financial support for further education and long term job commitment leading to promotion brought a substantial increase in retention to 93% in the proposed incentive packages. DCE in countries like Peru showed similar results that molded their policies accordingly for improved retention [33,34]. This study recommends to utilize initial years of fresh gradates for rural services as obligatory with lucrative investment in education as an incentive.…”

Quality of care provided by mid-level health workers: systematic review and meta-analysis

“…Any task-sharing strategy should be implemented alongside other strategies designed to increase the total number of health-care workers. [79][80][81][82] The main obstacle to ensuring that mid-level health workers can help improve health outcomes is that they are often ignored by government policies, health workforce strategies and health system support measures, despite their widespread use. Until these workers are more comprehensively taken into account and supported, their potential contribution will not be fully realized.…”

Preferências para o trabalho na atenção primária por estudantes de medicina em Minas Gerais, Brasil: evidências de um experimento de preferência declarada

“…Os DCE têm sido aplicados em diversos países para fundamentar decisões em relação às políticas de saúde, planejamento e alocação de recursos, sobretudo para orientar políticas de atração e retenção de recursos humanos em saúde em áreas de maior necessidade 11,12,13,14 . Em anos recentes, registrou-se um uso crescente desta técnica 15,16,17,18,19,20,21,22,23,24,25 . Acompanhando esse cenário recente e considerando a ausência de estudos do tipo no Brasil, o presente estudo teve como objetivo realizar um DCE a fim de investigar preferências por atributos de emprego de médicos na atenção primária à saúde.…”