For more than money

willingness of health professionals to stay in remote Senegal

Ayako Honda (Corresponding Author), Nicolas Krucien, Mandy Ryan, Ibrahima Ska Ndella Diouf, Malick Salla, Mari Nagai, Noriko Fujita

Research output: Contribution to journalArticle

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Abstract

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 (3,909 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.
Original languageEnglish
Article number28
JournalHuman Resources for Health
Volume17
DOIs
Publication statusPublished - 25 Apr 2019

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Senegal
health professionals
money
Health
health
training opportunities
Contracts
incentive
physician
Motivation
development policy
Policy Making
experiment
Physicians
worker
Interviews
reform policy
interview
Rural Health
Equipment and Supplies

Keywords

  • rural job retention
  • human resources for health
  • motivation
  • incentives
  • low- and middle- income countries
  • Senegal
  • discrete choice experiment
  • Human resources for health
  • Incentives
  • Rural job retention
  • Low- A nd middle-income countries
  • Motivation
  • Discrete choice experiment
  • RETENTION
  • WORKERS
  • MALAWI
  • Low- and middle-income countries
  • DISCRETE-CHOICE EXPERIMENT
  • PREFERENCES
  • AREAS

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Public Administration

Cite this

For more than money : willingness of health professionals to stay in remote Senegal. / Honda, Ayako (Corresponding Author); Krucien, Nicolas; Ryan, Mandy; Ndella Diouf, Ibrahima Ska; Salla, Malick; Nagai, Mari; Fujita, Noriko.

In: Human Resources for Health, Vol. 17, 28, 25.04.2019.

Research output: Contribution to journalArticle

Honda, Ayako ; Krucien, Nicolas ; Ryan, Mandy ; Ndella Diouf, Ibrahima Ska ; Salla, Malick ; Nagai, Mari ; Fujita, Noriko. / For more than money : willingness of health professionals to stay in remote Senegal. In: Human Resources for Health. 2019 ; Vol. 17.
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title = "For more than money: willingness of health professionals to stay in remote Senegal",
abstract = "BackgroundPoor 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.MethodsWorking 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 (3,909 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.ResultsFor 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.ConclusionContract 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.",
keywords = "rural job retention, human resources for health, motivation, incentives, low- and middle- income countries, Senegal, discrete choice experiment, Human resources for health, Incentives, Rural job retention, Low- A nd middle-income countries, Motivation, Discrete choice experiment, RETENTION, WORKERS, MALAWI, Low- and middle-income countries, DISCRETE-CHOICE EXPERIMENT, PREFERENCES, AREAS",
author = "Ayako Honda and Nicolas Krucien and Mandy Ryan and {Ndella Diouf}, {Ibrahima Ska} and Malick Salla and Mari Nagai and Noriko Fujita",
note = "The study was funded through a Research Grant for International Health, H25-11, from the Ministry of Health, Welfare and Labour, Japan (http://www.ncgm.go.jp/kaihatsu/), and undertaken as part of the project R{\'e}seau Vision Tokyo 2010, funded by the Japan International Cooperation Agency. Acknowledgement The authors would like to express their profound gratitude to the fieldwork team and to the health professionals who responded to the survey questionnaire. Thanks also to four reviewers whose comments have improved the paper. The datasets used and/or analysed in the study are available from the corresponding author on reasonable request.",
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T2 - willingness of health professionals to stay in remote Senegal

AU - Honda, Ayako

AU - Krucien, Nicolas

AU - Ryan, Mandy

AU - Ndella Diouf, Ibrahima Ska

AU - Salla, Malick

AU - Nagai, Mari

AU - Fujita, Noriko

N1 - The study was funded through a Research Grant for International Health, H25-11, from the Ministry of Health, Welfare and Labour, Japan (http://www.ncgm.go.jp/kaihatsu/), and undertaken as part of the project Réseau Vision Tokyo 2010, funded by the Japan International Cooperation Agency. Acknowledgement The authors would like to express their profound gratitude to the fieldwork team and to the health professionals who responded to the survey questionnaire. Thanks also to four reviewers whose comments have improved the paper. The datasets used and/or analysed in the study are available from the corresponding author on reasonable request.

PY - 2019/4/25

Y1 - 2019/4/25

N2 - BackgroundPoor 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.MethodsWorking 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 (3,909 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.ResultsFor 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.ConclusionContract 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.

AB - BackgroundPoor 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.MethodsWorking 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 (3,909 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.ResultsFor 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.ConclusionContract 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.

KW - rural job retention

KW - human resources for health

KW - motivation

KW - incentives

KW - low- and middle- income countries

KW - Senegal

KW - discrete choice experiment

KW - Human resources for health

KW - Incentives

KW - Rural job retention

KW - Low- A nd middle-income countries

KW - Motivation

KW - Discrete choice experiment

KW - RETENTION

KW - WORKERS

KW - MALAWI

KW - Low- and middle-income countries

KW - DISCRETE-CHOICE EXPERIMENT

KW - PREFERENCES

KW - AREAS

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