Abstract
BackgroundHealth worker shortage and maldistribution are among the biggest threats to health systems in Africa. New medical graduates are prime targets for recruitment to deprived rural areas. However, little research has been done to determine the influence of workers' background and future plans on their preference for rural practice incentives and characteristics. The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana.MethodsWe asked fourth-year Ghanaian medical students to rank the importance of rural practice attributes including salary, infrastructure, management style, and contract length in considering future jobs. We used bivariate and multivariate ordinal logistic regression to estimate the association between attribute valuation and students' socio-demographic background, educational experience, and future career plans.ResultsOf 310 eligible fourth year medical students, complete data was available for 302 students (97%). Students considering emigration ranked salary as more important than students not considering emigration, while students with rural living experience ranked salary as less important than those with no rural experience. Students willing to work in a rural area ranked infrastructure as more important than students who were unwilling, while female students ranked infrastructure as less important than male students. Students who were willing to work in a rural area ranked management style as a more important rural practice attribute than those who were unwilling to work in a rural area. Students studying in Kumasi ranked contract length as more important than those in Accra, while international students ranked contract length as less important than Ghanaian students.ConclusionsInterventions to improve rural practice conditions are likely to be more persuasive than salary incentives to Ghanaian medical students who are willing to work in rural environments a priori. Policy experiments should test the impact of these interventions on actual uptake by students upon graduation.
Highlights
Health worker shortage and maldistribution are among the biggest threats to health systems in Africa
Management style: Fee-paying students ranked management style as more important than sponsored students [odds ratio (OR) 1.93 (1.01-3.66)]. Those willing to work in a rural area ranked management style as more important than those unwilling to work in a rural area [OR 1.59 (1.02-2.47)]
Management Style: Younger students and those paying school fees ranked management style as a more important rural practice attribute than older students and sponsored students [OR 3.38 (1.0510.91); OR 2.32 (10.4-5.19)]. Those willing to work in a rural area ranked management style as a more important rural practice attribute than those unwilling to work in a rural area [OR 1.86 (1.093.17)]
Summary
Health worker shortage and maldistribution are among the biggest threats to health systems in Africa. Little research has been done to determine the influence of workers’ background and future plans on their preference for rural practice incentives and characteristics. The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana. Strategies to recruit and retain rural health workers vary widely, including education reforms (e.g. recruitment of rural students, conducting training programs in rural areas), professional and personal support (e.g. provisions for housing, training opportunities), financial incentives, and compulsory service [4,6,7,8,9,10,11]. Research on financial and non-financial incentives for deprived-area practice have been identified by policy-makers as having a high potential for health impact [15]
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