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

Abstract

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...

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.…”

“…Studies also suggests that monetary incentives should be of substantial value so that doctors can be attracted to work in remote areas [26][27][28].…”

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What can discrete choice experiments do for you?

“…Thus, proposals for new ways of providing, for example, medical education or alternative medical career paths can be evaluated in the first instance without 'real' (revealed preference) data that may not be feasible to collect or can only be collected through costly pilots. For example, Robyn et al 24 conducted a DCE amongst students and health workers in Cameroon to explore the impact of incentives on preferences for rural posts. Analysis of the preference data included estimating the impact on preferences of 10 separate 'packages', each of which offered different incentives.…”

Retention of qualified healthcare workers in rural Senegal: lessons learned from a qualitative study

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