Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment

Blaauw, Duane; Erasmus, Ermin; Pagaiya, Nonglak; Tangcharoensathein, V.; Mullei, K.; Mudhune, Sandra; Goodman, Catherine; English, Mike; Lagarde, Mylène

doi:10.2471/blt.09.072918

Cited by 133 publications

(154 citation statements)

References 27 publications

(31 reference statements)

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“…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.…”

Section: Introductionunclassified

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

et al. 2017

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Este artigo tem por objetivo apresentar os resultados da aplicação de um experimento de preferência declarada (DCE - discrete choice experiment) realizado em 2012 com 277 estudantes do último ano dos cursos de medicina do Estado de Minas Gerais, Brasil. O experimento permitiu investigar as preferências dos estudantes sobre o trabalho futuro como médicos na atenção primária à saúde, com base em de cenários de emprego hipotéticos que visavam aferir a probabilidade de deslocamento para áreas com escassez de médicos. A aplicação do DCE envolveu (i) uma etapa qualitativa para definição dos atributos e seus respectivos níveis que comporiam os cenários de emprego, (ii) uma etapa de construção e aplicação do instrumento e (iii) uma etapa de análise com a aplicação de logit multinomial de probabilidade condicional para estimativa dos pesos de cada atributo e construção de cenários de probabilidade de escolha. Os resultados apontaram que o atributo do emprego que mais impactou a escolha dos respondentes foi o de localização do trabalho, seguido por condições de trabalho, remuneração, acesso à residência médica, tipo de vínculo e carga de trabalho. Constatou-se que os entrevistados de faculdades privadas, com maior renda familiar e do sexo feminino, em geral, têm maior resistência para deslocar-se para as regiões urbanas inseguras e áreas remotas do interior. Os cenários de emprego que se mostraram mais plausíveis em termos de intervenção pública foram aqueles que combinavam os salários de valores intermediários, boas condições de trabalho e obtenção de 10 a 20 pontos adicionais nos exames de residência médica.

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Section: Introductionunclassified

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

et al. 2017

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“…Health worker preferences for human resource policy interventions vary significantly across countries. In Kenya and South Africa, better educational opportunities or rural allowances were identified to be most effective in increasing the uptake of rural posts, while in Thailand better health insurance coverage was identified as having the most effect on rural health worker retention (11). Moreover, there is a substantial body of literature on why health workers choose not to locate in rural areas (including reasons such as low pay and poor promotion opportunities), what type of incentives they value most in a job, and how this varies by type of individual (9,12).…”

Section: Introductionmentioning

confidence: 99%

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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“…[1] Yet, there still remains a problem with recruitment and retention of health workers, including nurses. In the US, rural hospitals and nurses are very important to rural communities that often face a lack of health care services and professionals, including hospital care, public health services, and long-term care.…”

Section: Introductionmentioning

confidence: 99%

“…[4] Just as in other areas of the world, recruitment and retention of rural nurses are a priority for US rural communities, including those in Washington State. [1,2] …”

Section: Introductionmentioning

confidence: 99%

Characteristics of commuting and non-commuting rural-dwelling nurses in eastern Washington

Lojas

Oneal

2015

JNEP

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Purpose: The purpose of this study was to explore characteristics of rural-dwelling nurses who may or may not commute for work to an urban area. Rural communities often face a lack of healthcare provider access, including lack of access to registered nurses. With 40% of hospitals and other healthcare facilities located in rural areas, there is a critical need to obtain information about rural nurse workforce issues. Limited research has been conducted on RNs who commute to work in urban areas. To extend this research and provide more information about rural commuting nurses, a pilot study was completed in three rural counties in Washington State. Methods: A convenience sample of 72 rural-dwelling nurses was recruited through email and mail invitation. Survey data were collected using Qualtrics software. Descriptive statistics were used to determine general characteristics. Chi-square analysis was used to compare respondents who commute to those who do not. Results: Differences noted between the commuting and non-commuting nurses included non-commuters being more likely to be dissatisfied overall with their primary facility, current base salary, and salary range for their position than commuters. There were no nurses in advanced practice in the non-commuting group. Conclusions: This pilot study supports the need for further research with larger samples and in more rural counties of eastern Washington to better assess needs and characteristics of both commuting and non-commuting nurses. This information can assist rural healthcare employers to develop and implement the most effective strategies to keep the rural nurse workforce in the community.

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Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment

Cited by 133 publications

References 27 publications

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

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

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

Characteristics of commuting and non-commuting rural-dwelling nurses in eastern Washington

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