Addressing Health Workforce Distribution Concerns: A Discrete Choice Experiment to Develop Rural Retention Strategies in Cameroon

Int J Health Policy Manag 2015; 4: 169–180. doi: 10.15171/ijhpm.2015.27

12 Pages Posted: 9 Mar 2015

See all articles by Paul Jacob Robyn

Paul Jacob Robyn

Cameroon Country Office

Zubin Shroff

World Health Organization

Omer Ramses Zang

Cameroon Country Office

Samuel Kingue

Ministry of Public Health; University of Yaounde I - Department of Internal Medicine and Specialities

Sebastien Djienouassi

Institute for Survey and Statistical Analysis

Christian Kouontchou

Institute for Survey and Statistical Analysis

Gaston Sorgho

Cameroon Country Office

Date Written: March 8, 2015

Abstract

Background Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH) is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas. Methods To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE) was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data. Results Among medical and nursing students a rural retention bonus of 75% of base salary (aOR=8.27, 95% CI: 5.28-12.96, P<0.001) and improved health facility infrastructure (aOR=3.54, 95% CI: 2.73-4.58) respectively were the attributes with the largest effect sizes. Among medical doctors and nurse aides, a rural retention bonus of 75% of base salary was the attribute with the largest effect size (medical doctors aOR=5.60, 95% CI: 4.12-7.61, P<0.001; nurse aides aOR=4.29, 95% CI: 3.11-5.93, P<0.001). On the other hand, improved health facility infrastructure (aOR=3.56, 95% CI: 2.75-4.60, P<0.001), was the attribute with the largest effect size among the state registered nurses surveyed. Willingness-to-Pay (WTP) estimates were generated for each health worker cadre for all the attributes. Preference impact measurements were also estimated to identify combination of incentives that health workers would find most attractive. Conclusion Based on these findings, the study recommends the introduction of a system of substantial monetary bonuses for rural service along with ensuring adequate and functional equipment and uninterrupted supplies. By focusing on the analysis of locally relevant, actionable incentives, generated through the involvement of policymakers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health.

Keywords: Cameroon; Human Resources For Health; Discrete Choice Experiment (DCE); Rural Retention Strategies

Suggested Citation

Robyn, Paul Jacob and Shroff, Zubin and Zang, Omer Ramses and Kingue, Samuel and Djienouassi, Sebastien and Kouontchou, Christian and Sorgho, Gaston, Addressing Health Workforce Distribution Concerns: A Discrete Choice Experiment to Develop Rural Retention Strategies in Cameroon (March 8, 2015). Int J Health Policy Manag 2015; 4: 169–180. doi: 10.15171/ijhpm.2015.27, Available at SSRN: https://ssrn.com/abstract=2575313

Paul Jacob Robyn (Contact Author)

Cameroon Country Office ( email )

Yaoundé
Cameroon

Zubin Shroff

World Health Organization ( email )

20 Avenue Appia
Geneva 27, CH-1211
Switzerland

Omer Ramses Zang

Cameroon Country Office ( email )

Yaoundé
Cameroon

Samuel Kingue

Ministry of Public Health ( email )

Yaounde
Cameroon

University of Yaounde I - Department of Internal Medicine and Specialities

Yaounde
Cameroon

Sebastien Djienouassi

Institute for Survey and Statistical Analysis ( email )

Yaoundé
Cameroon

Christian Kouontchou

Institute for Survey and Statistical Analysis ( email )

Yaoundé
Cameroon

Gaston Sorgho

Cameroon Country Office ( email )

Yaoundé
Cameroon

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