Job Preferences of Nurses and Midwives for Taking Up a Rural Job in Peru: A Discrete Choice Experiment

Luis Huicho,Duane Blaauw,Mylene Lagarde,J Jaime Miranda,Andrés G Lescano,Francisco Diez-Canseco,Claudia Lema,Alfredo Luis Fort

doi:10.1371/journal.pone.0050315

Abstract

BackgroundRobust evidence on interventions to improve the shortage of health workers in rural areas is needed. We assessed stated factors that would attract short-term contract nurses and midwives to work in a rural area of Peru.Methods and FindingsA discrete choice experiment (DCE) was conducted to evaluate the job preferences of nurses and midwives currently working on a short-term contract in the public sector in Ayacucho, Peru. Job attributes, and their levels, were based on literature review, qualitative interviews and focus groups of local health personnel and policy makers. A labelled design with two choices, rural community or Ayacucho city, was used. Job attributes were tailored to these settings. Multiple conditional logistic regressions were used to assess the determinants of job preferences. Then we used the best-fitting estimated model to predict the impact of potential policy incentives on the probability of choosing a rural job or a job in Ayacucho city. We studied 205 nurses and midwives. The odds of choosing an urban post was 14.74 times than that of choosing a rural one. Salary increase, health center-type of facility and scholarship for specialization were preferred attributes for choosing a rural job. Increased number of years before securing a permanent contract acted as a disincentive for both rural and urban jobs. Policy simulations showed that the most effective attraction package to uptake a rural job included a 75% increase in salary plus scholarship for a specialization, which would increase the proportion of health workers taking a rural job from 36.4% up to 60%.ConclusionsUrban jobs were more strongly preferred than rural ones. However, combined financial and non-financial incentives could almost double rural job uptake by nurses and midwifes. These packages may provide meaningful attraction strategies to rural areas and should be considered by policy makers for implementation.

Highlights

There is wide agreement on the need of evidence-based interventions to adequately face the health workforce crisis that affects health systems, in developing countries [1,2,3]
The study sample of nursing and midwifery’s health workers were mostly in their early thirties, predominantly female, almost two thirds were native to Ayacucho, and a similar proportion working in urban and rural areas
They had already worked for 2.4 years in a rural area

Summary

Introduction

There is wide agreement on the need of evidence-based interventions to adequately face the health workforce crisis that affects health systems, in developing countries [1,2,3]. Such interventions should be designed, implemented and evaluated with the support of a sound body of knowledge. Discrete choice experiments (DCE) have recently been applied to the field of human resources of health (HRH), to identify attraction and/or retention incentives for health care workers. DCE is a well-suited method to stated job preferences of health workers, given specified attributes and levels [7,8].

Methods

Results

Discussion

Conclusion