Abstract
BackgroundDoctors’ scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors’ stated preferences for rural jobs.Methods and FindingsA labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho’s capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%.ConclusionsDoctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden.
Highlights
Human resources for health have risen as a public health concern in the international agenda [1,2], and as a national research priority in Peru [3,4], where the health workforce is inequitably distributed [5,6]
Doctors are five times more likely to favour a job in urban areas over rural settings
We focused on doctors on short-term contracts rather than on those with permanent posts because the latter group is comprised by more senior doctors, already settled in urban areas and much less likely to consider moving to rural settings
Summary
Human resources for health have risen as a public health concern in the international agenda [1,2], and as a national research priority in Peru [3,4], where the health workforce is inequitably distributed [5,6]. Peru is one of the few countries in the region facing a health workforce crisis, with health workers density below the critical threshold of 2.3 per 1,0000 population [9] This crisis is evident in indicators of the geographical concentration of human resources [10,11], and in the perception of lay individuals. A recent survey of inhabitants of Lima, Peru’s capital, showed that they consider an insufficient number of doctors as the second most common problem affecting the quality of health service delivery [12] Not surprisingly, if such a negative perception exists in the capital where doctors are mostly concentrated, the picture in remote and rural areas is likely to be worse. We aimed to investigate doctors’ stated preferences for rural jobs
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