Journal Article

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

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

2019

Overview

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.

• Publisher: Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / AREAS / Developing Countries / DISCRETE-CHOICE EXPERIMENT / Economic models / Environmental and Occupational Health / Experiments / Female / Health Administration / Health care industry / Health Personnel / Health Personnel - organization & administration / Health services / Health Services Research / Human Resource Development / Human Resource Management / Human resources for health / Humans / Incentives / Job Satisfaction / Low- A nd middle-income countries / Low- and middle-income countries / MALAWI / Male / Management / Manpower policy / Medical personnel / Medicine / Medicine & Public Health / Medicine (General) / Midwifery / Models, Statistical / Motivation / Nurses / Personnel Selection / Personnel Selection - economics / Personnel Selection - methods / Physicians / Physicians - organization & administration / Population / Practice / Practice and Hospital Management / PREFERENCES / Professionals / Public Administration / Public aspects of medicine / Public Health / R5-920 / RA / RA Public aspects of medicine / RA1-1270 / RETENTION / Rural areas / Rural Health Services / Rural Health Services - organization & administration / Rural job retention / Salaries and Fringe Benefits / SDG 3 - Good Health and Well-being / Senegal / Shortages / Social Policy / WORKERS / Workforce