Abstract
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. 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. 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. 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 policy-makers 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.
Highlights
Every nation in the world faces shortages of health workers in rural areas
Data collection in the other two regions proceeded smoothly, with the survey team using the launch of the Performance-Based Financing (PBF) project in the East Region to take advantage of the large number of health workers that were participating in the regional launching
Policy implications and conclusions In order to respond to the severe geographic imbalances in health outcomes in Cameroon and improve coverage of essential health services, the national health workforce must be distributed in a manner that responds to populations’ health needs
Summary
Every nation in the world faces shortages of health workers in rural areas. Ensuring professionally trained, motivated health professionals are present to provide essential health services in even the most challenging areas is an essential step in the path towards universal health coverage [1,2,3]. 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] These types of studies do not provide respondents real lifelike job scenarios that allow for understanding the importance of various employment attributes of rural jobs that influence health worker decision-making behavior. We use a Discrete Choice Experiment (DCE) to examine health worker retention strategy attributes that influence health workers’ stated preferences for employment opportunities in remote areas To our knowledge, this is the first study to address health worker preferences for rural retention methods in Cameroon. By involving policy-makers from the design stage, we link research to policy development and action
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