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For more than money: willingness of health professionals to stay in remote Senegal

BACKGROUND: Poor distribution of already inadequate numbers of health professionals seriously constrains equitable access to health services in low- and middle-income countries. The Senegalese Government is currently developing policy to encourage health professionals to remain in areas defined as ‘...

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Autores principales: Honda, Ayako, Krucien, Nicolas, Ryan, Mandy, Diouf, Ibrahima Ska Ndella, Salla, Malick, Nagai, Mari, Fujita, Noriko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485088/
https://www.ncbi.nlm.nih.gov/pubmed/31023372
http://dx.doi.org/10.1186/s12960-019-0363-7
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author Honda, Ayako
Krucien, Nicolas
Ryan, Mandy
Diouf, Ibrahima Ska Ndella
Salla, Malick
Nagai, Mari
Fujita, Noriko
author_facet Honda, Ayako
Krucien, Nicolas
Ryan, Mandy
Diouf, Ibrahima Ska Ndella
Salla, Malick
Nagai, Mari
Fujita, Noriko
author_sort Honda, Ayako
collection PubMed
description BACKGROUND: Poor distribution of already inadequate numbers of health professionals seriously constrains equitable access to health services in low- and middle-income countries. The Senegalese Government is currently developing policy to encourage health professionals to remain in areas defined as ‘difficult’. Understanding health professional’s preferences is crucial for this policy development. METHODS: Working with the Senegalese Government, a choice experiment (CE) was developed to elicit the job preferences of physicians and non-physicians. Attributes were defined using a novel mixed-methods approach, combining interviews and best-worst scaling (Case 1). Six attributes were categorised as ‘individual (extrinsic) incentive’ attributes (‘type of contract’, ‘provision of training opportunities’, ‘provision of an allowance’ and ‘provision of accommodation’) or ‘functioning health system’ attributes (‘availability of basic equipment in health facilities’ and ‘provision of supportive supervision by health administrators’). Using face-to-face interviews, the CE was administered to 55 physicians (3909 observations) and 246 non-physicians (17 961 observations) randomly selected from those working in eight ‘difficult’ regions in Senegal. Conditional logit was used to analyse responses. This is the first CE to both explore the impact of contract type on rural retention and to estimate value of attributes in terms of willingness to stay (WTS) in current rural post. RESULTS: For both physicians and non-physicians, a permanent contract is the most important determinant of rural job retention, followed by availability of equipment and provision of training opportunities. Retention probabilities suggest that policy reform affecting only a single attribute is unlikely to encourage health professionals to remain in ‘difficult’ regions. The relative importance of an allowance is low; however, the level of such financial incentives requires further investigation. CONCLUSION: Contract type is a key factor impacting on retention. This has led the Senegalese Health Ministry to introduce a new rural assignment policy that recruits permanent staff from the pool of annually contracted healthcare professionals on the condition that they take up rural posts. While this is a useful policy development, further efforts to retain rural health workers, considering both personal incentives and the functioning of health systems, are necessary to ensure health worker numbers are adequate to meet the needs of rural communities.
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spelling pubmed-64850882019-05-03 For more than money: willingness of health professionals to stay in remote Senegal Honda, Ayako Krucien, Nicolas Ryan, Mandy Diouf, Ibrahima Ska Ndella Salla, Malick Nagai, Mari Fujita, Noriko Hum Resour Health Research BACKGROUND: Poor distribution of already inadequate numbers of health professionals seriously constrains equitable access to health services in low- and middle-income countries. The Senegalese Government is currently developing policy to encourage health professionals to remain in areas defined as ‘difficult’. Understanding health professional’s preferences is crucial for this policy development. METHODS: Working with the Senegalese Government, a choice experiment (CE) was developed to elicit the job preferences of physicians and non-physicians. Attributes were defined using a novel mixed-methods approach, combining interviews and best-worst scaling (Case 1). Six attributes were categorised as ‘individual (extrinsic) incentive’ attributes (‘type of contract’, ‘provision of training opportunities’, ‘provision of an allowance’ and ‘provision of accommodation’) or ‘functioning health system’ attributes (‘availability of basic equipment in health facilities’ and ‘provision of supportive supervision by health administrators’). Using face-to-face interviews, the CE was administered to 55 physicians (3909 observations) and 246 non-physicians (17 961 observations) randomly selected from those working in eight ‘difficult’ regions in Senegal. Conditional logit was used to analyse responses. This is the first CE to both explore the impact of contract type on rural retention and to estimate value of attributes in terms of willingness to stay (WTS) in current rural post. RESULTS: For both physicians and non-physicians, a permanent contract is the most important determinant of rural job retention, followed by availability of equipment and provision of training opportunities. Retention probabilities suggest that policy reform affecting only a single attribute is unlikely to encourage health professionals to remain in ‘difficult’ regions. The relative importance of an allowance is low; however, the level of such financial incentives requires further investigation. CONCLUSION: Contract type is a key factor impacting on retention. This has led the Senegalese Health Ministry to introduce a new rural assignment policy that recruits permanent staff from the pool of annually contracted healthcare professionals on the condition that they take up rural posts. While this is a useful policy development, further efforts to retain rural health workers, considering both personal incentives and the functioning of health systems, are necessary to ensure health worker numbers are adequate to meet the needs of rural communities. BioMed Central 2019-04-25 /pmc/articles/PMC6485088/ /pubmed/31023372 http://dx.doi.org/10.1186/s12960-019-0363-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Honda, Ayako
Krucien, Nicolas
Ryan, Mandy
Diouf, Ibrahima Ska Ndella
Salla, Malick
Nagai, Mari
Fujita, Noriko
For more than money: willingness of health professionals to stay in remote Senegal
title For more than money: willingness of health professionals to stay in remote Senegal
title_full For more than money: willingness of health professionals to stay in remote Senegal
title_fullStr For more than money: willingness of health professionals to stay in remote Senegal
title_full_unstemmed For more than money: willingness of health professionals to stay in remote Senegal
title_short For more than money: willingness of health professionals to stay in remote Senegal
title_sort for more than money: willingness of health professionals to stay in remote senegal
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485088/
https://www.ncbi.nlm.nih.gov/pubmed/31023372
http://dx.doi.org/10.1186/s12960-019-0363-7
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