Abstract
BackgroundThe lack of motivation of health workers to practice in rural areas remains a crucial problem for decision-makers, as it deprives the majority of access to health care. To solve the problem, many countries have implemented health worker retention strategies. However, the development of such strategies requires an understanding of the preferences of health workers. The objective of the study was to identify a package for attracting and retaining health workers in underserved areas.MethodsA cross sectional study was conducted in three health regions of Burkina Faso in 2012. A discrete choice experiment was used to investigate preferences for incentive packages among health workers recruited under the regionalized policy. In-depth interviews and focus group discussions with health workers currently working in the East and Sahel regions and policy makers, and a literature review on attraction and retention in low income countries, were performed to identify the attributes and levels. These attributes were: the regionalized recruitment policy, health insurance, work equipment, housing, and specific incentive compensation. The final design resulted in 16 choice sets. A multinomial logistic regression was used to determine the influence of socio-demographic characteristics on choice of a given option. A probit logistic regression model was then used to analyze the effect of these difference variables on choice, to identify the incentive package best suited to health workers. In total, questionnaires were administered to 315 regional health workers.ResultsFor all participants, choice of package was strongly influenced by length of commitment under the policy and provision of housing. Sex, number of years in profession, and location also influenced the choice of package. Women are twice more likely to choose a package with free housing and the cancellation of the policy.ConclusionIt is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas. In addition, the methodology of discrete choice experiment has been particularly useful, not only for better understanding the factors explaining the reluctance of health workers to work in underserved areas, but also to provide practical advice to the government, to improve its retention policy.
Highlights
The lack of motivation of health workers to practice in rural areas remains a crucial problem for decision-makers, as it deprives the majority of access to health care
The World Health Organization (WHO) estimates that 57 countries, including 36 in sub-Saharan Africa and six in South Asia, have a cumulative shortfall of 4.3 million health care workers. This shortfall is comprised of 2.4 million doctors, nurses, and midwives, with one million on the African continent alone [1]. In addition to this severe shortage of health care workers, there is the issue of their uneven distribution between urban and rural areas, keeping in mind that the majority of the population lives in rural areas [1]
The lack of motivation of health workers to practice in rural areas remains a crucial problem for decisionmakers, as it deprives a majority of the population of access to health care
Summary
The lack of motivation of health workers to practice in rural areas remains a crucial problem for decision-makers, as it deprives the majority of access to health care. The World Health Organization (WHO) estimates that 57 countries, including 36 in sub-Saharan Africa and six in South Asia, have a cumulative shortfall of 4.3 million health care workers. This shortfall is comprised of 2.4 million doctors, nurses, and midwives, with one million on the African continent alone [1]. In addition to this severe shortage of health care workers, there is the issue of their uneven distribution between urban and rural areas, keeping in mind that the majority of the population lives in rural areas [1]. In Niger, financial incentives for health personnel working in rural areas has improved the recruitment rate [2], while in Mali the program for the medicalization of rural health areas has retained doctors for four years [3]
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