Factors that influence midwifery students in Ghana when deciding where to practice: a discrete choice experiment

Peter Ageyi-Baffour,Mawuli Gyakobo,Sarah Rominski,Emmanuel Nakua,Jody R Lori

doi:10.1186/1472-6920-13-64

Abstract

BackgroundMal-distribution of the health workforce with a strong bias for urban living is a major constraint to expanding midwifery services in Ghana. According to the UN Millennium Development Goals (MDG) report, the high risk of dying in pregnancy or childbirth continues in Africa. Maternal death is currently estimated at 350 per 100,000, partially a reflection of the low rates of professional support during birth. Many women in rural areas of Ghana give birth alone or with a non-skilled attendant. Midwives are key healthcare providers in achieving the MDGs, specifically in reducing maternal mortality by three-quarters and reducing by two-thirds the under 5 child mortality rate by 2015.MethodsThis quantitative research study used a computerized structured survey containing a discrete choice experiment (DCE) to quantify the importance of different incentives and policies to encourage service to deprived, rural and remote areas by upper-year midwifery students following graduation. Using a hierarchical Bayes procedure we estimated individual and mean utility parameters for two hundred and ninety eight third year midwifery students from two of the largest midwifery training schools in Ghana.ResultsMidwifery students in our sample identified: 1) study leave after two years of rural service; 2) an advanced work environment with reliable electricity, appropriate technology and a constant drug supply; and 3) superior housing (2 bedroom, 1 bathroom, kitchen, living room, not shared) as the top three motivating factors to accept a rural posting.ConclusionAddressing the motivating factors for rural postings among midwifery students who are about to graduate and enter the workforce could significantly contribute to the current mal-distribution of the health workforce.

Highlights

IntroductionAccording to the UN Millennium Development Goals (MDG) report, the high risk of dying in pregnancy or childbirth continues in Africa
Mal-distribution of the health workforce with a strong bias for urban living is a major constraint to expanding midwifery services in Ghana
A health worker with midwifery skills should be present at every birth according to the joint statement by WHO/ UNFPA/UNICEF/World Bank [1]

Summary

Introduction

According to the UN Millennium Development Goals (MDG) report, the high risk of dying in pregnancy or childbirth continues in Africa. Maternal death is currently estimated at 350 per 100,000, partially a reflection of the low rates of professional support during birth. Many women in rural areas of Ghana give birth alone or with a non-skilled attendant. The UN’s Millennium Development Goal (MDG) 5, set in 2000, targeted a 75% reduction in the maternal mortality ratio by 2015. Maternal death is currently estimated at 350 per 100,000, in part a reflection of the low rates of professional or skilled support during childbirth [4]. While there is high uptake of prenatal care, estimated as high as 94 percent, many women in Ghana give birth alone or with a non-skilled attendant [5,6]. If access to skilled a birth attendant improves, women’s lives could be saved and morbidity drastically reduced

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