Abstract
BackgroundClinical officers (COs), a mid-level cadre of health worker, are the backbone of healthcare provision in rural Kenya. However, the vacancy rate for COs in rural primary healthcare facilities is high. Little is known about factors motivating COs’ preferences for rural postings.MethodsA discrete choice experiment (DCE) questionnaire was used with 57 COs at public health facilities in nine districts of Nyanza Province, Kenya. The questionnaire was developed on the basis of formative qualitative interviews with COs (n = 5) and examined how five selected job attributes influenced COs’ preferences for working in rural areas. Conditional logit models were employed to examine the relative importance of different job attributes.ResultsAnalysis of the qualitative data revealed five important job attributes influencing COs’ preferences: quality of the facility, educational opportunities, housing, monthly salary and promotion. Analysis of the DCE indicated that a 1-year guaranteed study leave after 3 years of service would have the greatest impact on retention, followed by good quality health facility infrastructure and equipment and a 30% salary increase. Sub-group analysis shows that younger COs demonstrated a significantly stronger preference for study leave than older COs. Female COs placed significantly higher value on promotion than male COs.ConclusionsAlthough both financial incentives and non-financial incentives were effective in motivating COs to stay in post, the study leave intervention was shown to have the strongest impact on COs’ retention in our study. Further research is required to examine appropriate interventions at each career stage that might boost COs’ professional identity and status but without leading to larger deficits in the availability of generalist COs.
Highlights
Clinical officers (COs), a mid-level cadre of health worker, are the backbone of healthcare provision in rural Kenya
Some COs directly mentioned the need for financial incentives in rural areas, “...so as to bring people who are working in towns to come and assist in the village.” [CO3]
mid-level workers (MLWs) including COs are used in many developing countries, more sound evidence is required to gain a better understanding of their motivational factors for retention in rural regions [1]
Summary
Clinical officers (COs), a mid-level cadre of health worker, are the backbone of healthcare provision in rural Kenya. The World Health Organization (WHO) recommends the utilization of mid-level workers (MLWs) to increase access to health workers in rural areas [1]. Since their training period is relatively short, and their remuneration is lower than that of physicians, MLWs are seen to be more financially advantageous in resource-limited settings [2]. According to a DCE guide by WHO, the World Bank and USAID [9], the tool can be used to investigate the impact of factors that influence retention of the health workforce in rural areas. The method allows researchers to estimate the strength of preferences for specific job attributes [10]
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