Incentivos para atraer y retener personal de salud de zonas rurales del Perú: un estudio cualitativo

Huicho, Luis; Diez-Canseco, Francisco; Lema, Claudia Patricia Henao; Miranda, J. Jaime; Lescano, Andrés G.

doi:10.1590/s0102-311x2012000400012

Cited by 26 publications

(47 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As we showed in a related qualitative study, doctors, nurses, midwives and nurse technicians incentives all feel that the rural setting is clearly a disadvantageous place to remain for themselves and their families, and they therefore considered it as a place to stay only transiently, while waiting for better job opportunities [26].…”

Section: Discussionmentioning

confidence: 80%

“…Unfortunately, this flexibility for hiring professionals for short-term periods is also related to job instability expressed by the fact that employees can be fired at any moment or may lose their job when their contract period ends [12], [16]. Therefore contratados may be willing to accept rural posts if they feel that in this way they will assure a position for a few years, as revealed by our related qualitative study [26]. Our current DCE also showed that lengthening the waiting time before getting a permanent post acted as a significant disincentive factor, although it was not particularly powerful, and therefore that decreasing this waiting time would act as a an incentive, a point we also discuss in the section on policy simulations.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Job Preferences of Nurses and Midwives for Taking Up a Rural Job in Peru: A Discrete Choice Experiment

et al. 2012

Self Cite

View full text Add to dashboard Cite

BackgroundRobust evidence on interventions to improve the shortage of health workers in rural areas is needed. We assessed stated factors that would attract short-term contract nurses and midwives to work in a rural area of Peru.Methods and FindingsA discrete choice experiment (DCE) was conducted to evaluate the job preferences of nurses and midwives currently working on a short-term contract in the public sector in Ayacucho, Peru. Job attributes, and their levels, were based on literature review, qualitative interviews and focus groups of local health personnel and policy makers. A labelled design with two choices, rural community or Ayacucho city, was used. Job attributes were tailored to these settings. Multiple conditional logistic regressions were used to assess the determinants of job preferences. Then we used the best-fitting estimated model to predict the impact of potential policy incentives on the probability of choosing a rural job or a job in Ayacucho city. We studied 205 nurses and midwives. The odds of choosing an urban post was 14.74 times than that of choosing a rural one. Salary increase, health center-type of facility and scholarship for specialization were preferred attributes for choosing a rural job. Increased number of years before securing a permanent contract acted as a disincentive for both rural and urban jobs. Policy simulations showed that the most effective attraction package to uptake a rural job included a 75% increase in salary plus scholarship for a specialization, which would increase the proportion of health workers taking a rural job from 36.4% up to 60%.ConclusionsUrban jobs were more strongly preferred than rural ones. However, combined financial and non-financial incentives could almost double rural job uptake by nurses and midwifes. These packages may provide meaningful attraction strategies to rural areas and should be considered by policy makers for implementation.

show abstract

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Job Preferences of Nurses and Midwives for Taking Up a Rural Job in Peru: A Discrete Choice Experiment

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…These attributes were: type of health facility, monthly net income, time in post before getting a permanent job, points when applying for a residency in Community and Family Medicine after three years in post, provision of free housing, work schedule (excluding holidays), and number of allowance/free days for continuous medical education (Table 1). While our qualitative study performed before this DCE study found that nurses and midwives consistently expressed recognition for their jobs as a relevant incentive, this issue did not emerge strongly from the interviews and focus groups with doctors [24]. Therefore, we decided not to include this particular attribute in the final DCE design for doctors, whereas we included it in the final design for nurses and midwives.…”

Section: Methodsmentioning

confidence: 98%

“…The identification of the most relevant attributes and levels to include in the DCE relied on several methods: in-depth interviews and focus groups performed with health providers currently working in Ayacucho [24], review of the international literature on attraction and retention strategies in low and middle-income countries [1], and interviews with policy makers.…”

Section: Methodsmentioning

confidence: 99%

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

Miranda

Diez-Canseco

Lema³

et al. 2012

PLoS ONE

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Incluso en Sudáfrica se refieren al servicio social de medicina como un periodo de "esclavitud" necesario para seguir con el desarrollo profesional (27) . Esto puede explicar la falta de atracción y la incapacidad en retener a los serumistas para trabajar en el futuro en las zonas vulnerables (28) ; con una "bola de nieve" de comentarios que influye en las decisiones de los futuros serumistas y profesionales que hayan culminado este programa (29) .…”

Section: Falta De Compromiso E Identificaciónunclassified

El requisito obligatorio del servicio social en salud del Perú: discriminatorio e inconstitucional

Mayta‐Tristán

Poterico

Galán-Rodas

et al. 2014

Rev Peru Med Exp Salud Publica

View full text Add to dashboard Cite

RESUMENEl servicio rural y urbano marginal en salud (SERUMS) es una actividad que realizan solo los profesionales de la salud al Estado peruano, ya que constituye un requisito obligatorio para optar por la segunda especialidad o para trabajar en un centro de salud público, y obtener becas del gobierno para futura capacitación. Los escasos cambios legales en el reglamento de este programa social y el enfoque de "servicio" restringido a los profesionales de salud conllevan a que esta política sea discriminatoria e inconstitucional por atentar contra el derecho a la educación y al trabajo. No hay evidencia científica que sustente la utilidad y efectividad de este programa, tanto en la calidad de servicio y mejora de indicadores sanitarios, como en la adecuada distribución y retención de profesionales de salud. Sugerimos abolir el requisito de obligatoriedad y replantear una estrategia política que ayude a atraer y retener a los profesionales de la salud en zonas vulnerables del Perú. Palabras clave: Recursos humanos; Distribución de médicos; Trabajadores rurales; Salud pública; Políticas; Perú (fuente: DeCS BIREME). MANDATORY REQUIREMENT OF SOCIAL HEALTH SERVICE IN PERU:DISCRIMINATORY AND UNCONSTITUTIONAL RESUMENThe rural and urban-edge health service (SERUMS) is an activity that only health professionals perform for the Peruvian government, as it is a mandatory requirement to qualify for a second specialty or to work in public hospitals and public health care facilities, and obtain government scholarships for future training. The few legal changes in the rules of this social program and the focus of "service" restricted to health professionals lead to a perception of this policy as discriminatory and unconstitutional because it violates the right to education and work. There is no scientific evidence that supports the usefulness and effectiveness of this program in terms of quality of service and health indicator improvement, as well as in adequate distribution and retention of health professionals. We suggest to abolish the compulsory requirement and to reformulate a political strategy to help attract and retain health professionals in vulnerable areas of Peru.

show abstract

Incentivos para atraer y retener personal de salud de zonas rurales del Perú: un estudio cualitativo

Cited by 26 publications

References 15 publications

Job Preferences of Nurses and Midwives for Taking Up a Rural Job in Peru: A Discrete Choice Experiment

Job Preferences of Nurses and Midwives for Taking Up a Rural Job in Peru: A Discrete Choice Experiment

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

El requisito obligatorio del servicio social en salud del Perú: discriminatorio e inconstitucional

Contact Info

Product

Resources

About