scholarly journals Analysis of policy interventions to attract and retain nurse midwives in rural areas of Malawi: A discrete choice experiment

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253518
Author(s):  
Leslie Berman ◽  
Levison Nkhoma ◽  
Margaret Prust ◽  
Courtney McKay ◽  
Mihereteab Teshome ◽  
...  
Keyword(s):  
Health Worker ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Rural Areas ◽  
Choice Experiment ◽  
Health Workers ◽  
Scale Up ◽  
Unequal Distribution ◽  
Recruitment And Retention ◽  
Facility Level

Background Inadequate and unequal distribution of health workers are significant barriers to provision of health services in Malawi, and challenges retaining health workers in rural areas have limited scale-up initiatives. This study therefore aims to estimate cost-effectiveness of monetary and non-monetary strategies in attracting and retaining nurse midwife technicians (NMTs) to rural areas of Malawi. Methods The study uses a discrete choice experiment (DCE) methodology to investigate importance of job characteristics, probability of uptake, and intervention costs. Interviews and focus groups were conducted with NMTs and students to identify recruitment and retention motivating factors. Through policymaker consultations, qualitative findings were used to identify job attributes for the DCE questionnaire, administered to 472 respondents. A conditional logit regression model was developed to produce probability of choosing a job with different attributes and an uptake rate was calculated to estimate the percentage of health workers that would prefer jobs with specific intervention packages. Attributes were costed per health worker year. Results Qualitative results highlighted housing, facility quality, management, and workload as important factors in job selection. Respondents were 2.04 times as likely to choose a rural job if superior housing was provided compared to no housing (CI 1.71–2.44, p<0.01), and 1.70 times as likely to choose a rural job with advanced facility quality (CI 1.47–1.96, p<0.01). At base level 43.9% of respondents would choose a rural job. This increased to 61.5% if superior housing was provided, and 72.5% if all facility-level improvements were provided, compared to an urban job without these improvements. Facility-level interventions had the lowest cost per health worker year. Conclusions Our results indicate housing and facility-level improvements have the greatest impact on rural job choice, while also creating longer-term improvements to health workers’ living and working environments. These results provide practical evidence for policymakers to support development of workforce recruitment and retention strategies.

scholarly journals Employment preferences of obstetricians and gynecologists to work in the district hospitals: evidence from a discrete choice experiment in Nepal

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Bishnu Gautam ◽  
Vishnu Prasad Sapkota ◽  
Rajendra Raj Wagle
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Health Workers ◽  
Fractional Factorial ◽  
Model Parameters ◽  
Job Attributes ◽  
Recruitment And Retention ◽  
District Hospitals ◽  
Choice Sets

Abstract Background A mismatch between the requirement and annual production of obstetricians and gynecologists (OBs-GYNs) was observed in Nepal. On top of that, recruitment and retention of OBs-GYNs is a pressing problem, especially in district hospitals of Nepal. In this connection, evidence on the job priorities and preferences of OBs-GYNs, which is currently lacking in Nepal, would help in policymakers in devising recruitment and retention strategies in these hospitals. This study, therefore, aims at exploring the most relevant job attributes that OBs-GYNs would prefer to work in the district hospitals of Nepal using a discrete choice experiment (DCE) technique. Methods Job attributes relevant to design the questionnaire were identified using keyinformant interviews and focusgroup discussions with policymakers and top managers. Then, 48 choice sets were developed using a fractional factorial design. Using these unlabeled choice sets, a DCE was conducted among 189 OBs-GYNs. The multinomial logistic regression model was used to estimate the marginal utilities and other model parameters. The willingness to pay/accept estimates was also measured for each job attribute. Results OBs-GYNs preferred the presence of a full team at the workplace (OB-GYN, pediatrician, and anesthesiologist), provision of primary and secondary education for children, and opportunity of private practice. On the other hand, a few job attributes such as a higher duration of service in district hospitalsand the provisions of a car allowance were preferred less by the respondents. Results from the marginal utility by the OBs-GYNs would be open to trade among the attributes. Conclusions The job attributes identified as incentives in this study should be included in a package to attract OBs-GYNs to serve in district hospitals of Nepal rather than offering a standard incentive package to all health workers. Similarly, this study confirmed the importance of the combination of non-monetary and monetary interventions in attracting and retaining health workers in district hospitals of Nepal.

scholarly journals Job preferences of medical and nursing students seeking employment in rural China: a discrete choice experiment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Meiling Bao ◽  
Cunrui Huang
Keyword(s):  
Nursing Students ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Rural Areas ◽  
Choice Experiment ◽  
Health Workers ◽  
Rural China ◽  
Mixed Logit ◽  
Fractional Factorial ◽  
Guizhou Province

Abstract Background China has a shortage of health workers in rural areas, but little research exists on policies that attract qualified medical and nursing students to rural locations. We conducted a discrete choice experiment to determine how specific incentives would be valued by final–year students in a medical university in Guizhou Province, China. Methods Attributes of potential jobs were developed through the literature review, semi–structured interviews, and a pilot survey. Forty choice sets were developed using a fractional factorial design. A mixed logit model was used to estimate the relative strength of the attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates. Results The final sample comprised 787 medical and nursing students. The statistically significant results indicated “Bianzhi” (the number of personnel allocated to each employer by the government) and physical conflicts between doctors and patients were two of the most important non-monetary job characteristics that incentivized both medical and nursing students. Policy simulation suggested that respondents were most sensitive to a salary increase, and the effect of incentive packages was stronger for students with a rural family background. Conclusions Strategies for patient–doctor relationships, Bianzhi and salary should be considered to attract final–year medical and nursing students to work in rural China. In addition, specific recruitment policy designs tailored for students with different majors and backgrounds should be taken into account.

scholarly journals Job preferences of undergraduate pharmacy students in China: a discrete choice experiment

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ping Liu ◽  
Shimeng Liu ◽  
Tiantian Gong ◽  
Quan Li ◽  
Gang Chen ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Rural Areas ◽  
Choice Experiment ◽  
Job Characteristics ◽  
Pharmacy Students ◽  
Preference Heterogeneity ◽  
Short Supply ◽  
Job Preferences ◽  
Open Management

Abstract Background Pharmacists are a crucial part of the health workforce and play an important role in achieving universal health coverage. In China, pharmaceutical human resources are in short supply, and the distribution is unequal. This study aimed to identify the key job characteristics that influence the job preferences of undergraduate pharmacy students and to elicit the relative importance of different job characteristics to shed light on future policy interventions. Methods A discrete choice experiment was conducted to assess the job preferences of undergraduate pharmacy students from 6 provinces in mainland China. A face-to-face interview was used to collect data. Conditional logit and mixed logit models were used to analyse data, and the final model was chosen according to the model fit statistics. A series of policy simulations was also conducted. Results In total, 581 respondents completed the questionnaire, and 500 respondents who passed the internal consistency test were analysed. All attributes were statistically significant except for open management. Monthly income and work location were most important to respondents, followed by work unit (which refers to the nature of the workplace) and years to promotion. There was preference heterogeneity among respondents, e.g., male students preferred open management, and female students preferred jobs in public institutions. Furthermore, students with an urban background or from a single-child family placed higher value on a job in the city compared to their counterparts. Conclusion The heterogeneity of attributes showed the complexity of job preferences. Both monetary and nonmonetary job characteristics significantly influenced the job preferences of pharmacy students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both incentives on the job itself and the background of pharmacy school graduates.

scholarly journals Understanding Health Workers’ Job Preferences to Improve Rural Retention in Timor-Leste: Findings from a Discrete Choice Experiment

PLoS ONE ◽  
2016 ◽  
Vol 11 (11) ◽  
pp. e0165940 ◽  
Author(s):  
Marc-Francois Smitz ◽  
Sophie Witter ◽  
Christophe Lemiere ◽  
Patrick Hoang-Vu Eozenou ◽  
Tomas Lievens ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Health Workers ◽  
Job Preferences ◽  
Timor Leste ◽  
Rural Retention

scholarly journals Job preferences for medical and nursing students to work in rural Guizhou Province, China: a discrete choice experiment

2020 ◽  
Author(s):  
Meiling Bao ◽  
Cunrui Huang
Keyword(s):  
Nursing Students ◽  
Discrete Choice ◽  
Rural Areas ◽  
Choice Experiment ◽  
Health Workers ◽  
Mixed Logit ◽  
Guizhou Province ◽  
Medical Order ◽  
Medical University ◽  
Education Opportunity

Abstract Background Maldistribution of health workers between urban and rural areas has been a critical difficulty in China. The shortage of health workers in disadvantaged areas reduces access to essential health services delivery, and adversely affects the population health. Policies on attracting health workers to locate in rural areas are needed to be explored. In order to identify the appropriate incentives, we conducted a discrete choice experiment to determine how specific job attributes might be valued by final year students in medical university in Guizhou Province, China. Methods Attributes of potential job were developed through literature review, in-depth semi-structured interviews and pretest. Salary, education opportunity, transportation, job location, workload, essential equipment, medical order, and identification ('bianzhi') were included. The questionnaire was formulated through a fractional factorial experiment design using %MktRuns macros of SAS 9.4. All medical and nursing students in the final year at Guizhou Medical University were invited to participate in the study. Mixed logit model was used to estimate stated preferences of attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates. Results The final sample comprised 787 respondents, including 388 medical students and 399 nursing students. Attributes were statistically significant (with the exception of once every two years for education opportunity) and had expected signs. The results indicate that physical conflict between doctors and patients and identification ('bianzhi') were two of the most important non-monetary job characteristics for both medical and nursing students. And nursing students placed more value on identification ('bianzhi'). Policy simulation suggests that as for the individual incentive respondents were most sensitive to salary increasing. Incentive packages effects were stronger for students from rural background. Conclusions Strategies on medical order, identification ('bianzhi') and salary should be considered to attract final year medical and nursing students to work in rural areas. In addition, specific recruitment policy design tailored for subgroups should be taken into account.

scholarly journals Understanding community health worker incentive preferences in Uganda using a discrete choice experiment

2021 ◽  
Vol 11 ◽  
Author(s):  
Smisha Agarwal ◽  
Timothy Abuya ◽  
Richard Kintu ◽  
Daniel Mwanga ◽  
Melvin Obadha ◽  
...  
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment

scholarly journals What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India

2019 ◽  
Vol 4 (3) ◽  
pp. e001509 ◽  
Author(s):  
Marwa Abdel-All ◽  
Blake Angell ◽  
Stephen Jan ◽  
Martin Howell ◽  
Kirsten Howard ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Latent Class ◽  
Health Workers ◽  
Family Health ◽  
Health Check ◽  
Social Health ◽  
Significant Heterogeneity ◽  
Group 3

IntroductionA number of factors contribute to the performance and motivation of India’s Accredited Social Health Activists (ASHAs). This study aims to identify the key motivational factors (and their relative importance) that may help retain ASHAs in service.MethodsA discrete choice experiment (DCE) survey presented ASHAs with eight unlabelled choice sets, each describing two hypothetical jobs that varied based on five attributes, specifically salary, workload, travel allowance, supervision and other job benefits. Multinomial logit and latent class (LC) models were used to estimate stated preferences for the attributes.ResultWe invited 318 ASHAs from 53 primary health centres of Guntur, a district in south India. The DCE was completed by 299 ASHAs using Android tablets. ASHAs were found to exhibit a strong preference for jobs that incorporated training leading to promotion, a fixed salary and free family healthcare. ASHAs were willing to sacrifice 2530 Indian rupee (INR) from their monthly salary, for a job offering training leading to promotion opportunity and 879 INR for a free family health-check. However, there was significant heterogeneity in preferences across the respondents. The LC model identified three distinct groups (comprising 51%, 35% and 13% of our cohort, respectively). Group 1 and 2 preferences were dominated by the training and salary attributes with group 2 having higher preference for free family health-check while group 3 preferences were dominated by workload. Relative to group 3, ASHAs in groups 1 and 2 were more likely to have a higher level of education and less likely to be the main income earners for their families.ConclusionASHAs are motivated by both non-financial and financial factors and there is significant heterogeneity between workers. Policy decisions aimed at overcoming workforce attrition should target those areas that are most valued by ASHAs to maximise the value of investments into these workers.Trial registration numberCTRI/2018/03/012425.

scholarly journals Stated Preferences of Doctors for Choosing a Job in Rural Areas of Peru: A Discrete Choice Experiment

PLoS ONE ◽  
2012 ◽  
Vol 7 (12) ◽  
pp. e50567 ◽  
Author(s):  
J. Jaime Miranda ◽  
Francisco Diez-Canseco ◽  
Claudia Lema ◽  
Andrés G. Lescano ◽  
Mylene Lagarde ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Rural Areas ◽  
Choice Experiment ◽  
Stated Preferences

scholarly journals Understanding public health providers’ preferences for interventions against informal payment in Tanzania: a discrete choice experiment

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Binyaruka
Keyword(s):  
Public Health ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Private Practice ◽  
Choice Experiment ◽  
Multinomial Logit ◽  
Health Providers ◽  
Informal Payment ◽  
Survey Tool ◽  
Facility Level

Abstract Background Informal payments are regressive. They can limit the access to quality healthcare, particularly of the most vulnerable, and are potentially catastrophic. Little is known in terms of providers' preferences for interventions. Methods We conducted a cross-sectional discrete choice experiment (DCE) among 432 health providers from 42 public health facilities (hospitals and health centres) in seven districts from Pwani region and five districts from Dar es Salaam region. The DCE attributes were derived from a scoping literature review, qualitative interview from 27 key informants from three districts, and through workshop with health providers, managers and policy makers. The final DCE survey tool included 12 unlabeled choice sets, each describing two hypothetical jobs that varied across six attributes: mode of payment, supervision at facility, opportunity for private practice, awareness and monitoring, measures against informal payment, and incentive payment for lack informal payment in the past 6 months. Multinomial logit and mixed multinomial logit methods were used to estimate preferences for the attributes. Results All attribute-levels, apart from supervision at the facility level, were significantly influencing health providers' choice decisions for job type (p &lt; 0.001). The most preferred attributes were measures for awareness creation and monitoring -i.e. preferences were significantly higher for facility with noticeboard (coefficient 0.39, 95% CI 0.29 -0.48 ), followed by provision of receipts (0.34, 0.24 -0.44) and presence of hotline number for reporting corrupt practices (0.26, 0.17 -0.35). Opportunity for private practice was significantly preferred (0.38, 0.31-045) and job preference increases as salary top-up increases (0.06, 0.05-0.7). The less preferred attributes were cash payment for healthcare (-0.27, -0.35- -0.19) and disciplinary measures at the district (-0.15, -0.23 - -0.07) or facility level (-0.10, -0.17- -0.03).

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