Job Preferences of Nurses and Midwives for Taking Up a Rural Job in Peru: A Discrete Choice Experiment

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Abstract

Background

Robust evidence on interventions to improve the shortage of health workers in rural areas is needed. We assessed stated factors that would attract short-term contract nurses and midwives to work in a rural area of Peru.

Methods and Findings

A discrete choice experiment (DCE) was conducted to evaluate the job preferences of nurses and midwives currently working on a short-term contract in the public sector in Ayacucho, Peru. Job attributes, and their levels, were based on literature review, qualitative interviews and focus groups of local health personnel and policy makers. A labelled design with two choices, rural community or Ayacucho city, was used. Job attributes were tailored to these settings. Multiple conditional logistic regressions were used to assess the determinants of job preferences. Then we used the best-fitting estimated model to predict the impact of potential policy incentives on the probability of choosing a rural job or a job in Ayacucho city. We studied 205 nurses and midwives. The odds of choosing an urban post was 14.74 times than that of choosing a rural one. Salary increase, health center-type of facility and scholarship for specialization were preferred attributes for choosing a rural job. Increased number of years before securing a permanent contract acted as a disincentive for both rural and urban jobs. Policy simulations showed that the most effective attraction package to uptake a rural job included a 75% increase in salary plus scholarship for a specialization, which would increase the proportion of health workers taking a rural job from 36.4% up to 60%.

Conclusions

Urban jobs were more strongly preferred than rural ones. However, combined financial and non-financial incentives could almost double rural job uptake by nurses and midwifes. These packages may provide meaningful attraction strategies to rural areas and should be considered by policy makers for implementation.

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Most cited references 12

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A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas.

Nathan Wilson, Ian D Couper, Elma de Vries … (2015)

The shortage of healthcare professionals in rural communities is a global problem that poses a serious challenge to equitable healthcare delivery. Both developed and developing countries report geographically skewed distributions of healthcare professionals, favouring urban and wealthy areas, despite the fact that people in rural communities experience more health related problems. This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors to rural and remote areas. A comprehensive search of the English literature was conducted using the National Library of Medicine's (PubMed) database and the keywords '(rural OR remote) AND (recruitment OR retention)' on 3 July 2008. In total, 1261 references were identified and screened; all primary studies that reported the outcome of an actual intervention and all relevant review articles were selected. Due to the paucity of prospective primary intervention studies, retrospective observational studies and questionnaire-driven surveys were included as well. The search was extended by scrutinizing the references of selected articles to identify additional studies that may have been missed. In total, 110 articles were included. In order to provide a comprehensive overview in a clear and user-friendly fashion, the available evidence was classified into five intervention categories: Selection, Education, Coercion, Incentives and Support - and the strength of the available evidence was rated as convincing, strong, moderate, weak or absent. The main definitions used to define 'rural and/or remote' in the articles reviewed are summarized, before the evidence in support of each of the five intervention categories is reflected in detail. We argue for the formulation of universal definitions to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy.

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Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment

D Blaauw, E Erasmus, N Pagaiya … (2010)

OBJECTIVE: To evaluate the relative effectiveness of different policies in attracting nurses to rural areas in Kenya, South Africa and Thailand using data from a discrete choice experiment (DCE). METHODS: A labelled DCE was designed to model the relative effectiveness of both financial and non-financial strategies designed to attract nurses to rural areas. Data were collected from over 300 graduating nursing students in each country. Mixed logit models were used for analysis and to predict the uptake of rural posts under different incentive combinations. FINDINGS: Nurses' preferences for different human resource policy interventions varied significantly between the three countries. In Kenya and South Africa, better educational opportunities or rural allowances would be most effective in increasing the uptake of rural posts, while in Thailand better health insurance coverage would have the greatest impact. CONCLUSION: DCEs can be designed to help policy-makers choose more effective interventions to address staff shortages in rural areas. Intervention packages tailored to local conditions are more likely to be effective than standardized global approaches.

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Labeled versus unlabeled discrete choice experiments in health economics: an application to colorectal cancer screening.

Esther W. de Bekker-Grob, Lieke Hol, Bas Donkers … (2009)

Discrete choice experiments (DCEs) in health economics commonly present choice sets in an unlabeled form. Labeled choice sets are less abstract and may increase the validity of the results. We empirically compared the feasibility, respondents' trading behavior, and convergent validity between a labeled and an unlabeled DCE for colorectal cancer (CRC) screening programs in The Netherlands. A labeled DCE version presented CRC screening test alternatives as "fecal occult blood test,"sigmoidoscopy," and "colonoscopy," whereas the unlabeled DCE version presented them as "screening test A" and "screening test B." Questionnaires were sent to participants and nonparticipants in CRC screening. Total response rate was 276 (39%) out of 712 and 1033 (46%) out of 2267 for unlabeled and labeled DCEs, respectively (P<0.001). The labels played a significant role in individual choices; approximately 22% of subjects had dominant preferences for screening test labels. The convergent validity was modest to low (participants in CRC screening: r=0.54; P=0.01; nonparticipants: r=0.17; P=0.45) largely because of different preferences for screening frequency. This study provides important insights in the feasibility and difference in results from labeled and unlabeled DCEs. The inclusion of labels appeared to play a significant role in individual choices but reduced the attention respondents give to the attributes. As a result, unlabeled DCEs may be more suitable to investigate trade-offs between attributes and for respondents who do not have familiarity with the alternative labels, whereas labeled DCEs may be more suitable to explain real-life choices such as uptake of cancer screening.

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Author and article information

Contributors

Alfredo Luis Fort: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2012

Publication date (Electronic): 20 December 2012

Volume: 7

Issue: 12

Electronic Location Identifier: e50315

Affiliations

[1 ]School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru

[2 ]School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru

[3 ]Instituto Nacional de Salud del Niño, Lima, Peru

[4 ]CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru

[5 ]Salud Sin Límites Perú, Lima, Peru

[6 ]Department of Parasitology, and Public Health Training Program, US Naval Medical Research Unit 6 (NAMRU-6), Lima, Peru

[7 ]School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru

[8 ]Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom

[9 ]Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa

World Health Organization, Switzerland

Author notes

* E-mail: lhuicho@ 123456gmail.com

Competing Interests: The authors have declared that no competing interests exist.

Analyzed the data: AGL JJM LH. Conceived the study and obtained funding for it: LH JJM CL. Designed the DCE study: JJM FDC CL AGL ML DB LH. Conducted the fieldwork activities: FDC. Supervised the fieldwork activities: LH. Provided direct support for data analysis: DB ML. Drafted the first version of the manuscript: LH. Participated in writing of the manuscript, provided important intellectual content and gave their final approval of the version submitted for publication: JJM FDC CL AGL ML DB.

Article

Publisher ID: PONE-D-12-23559

DOI: 10.1371/journal.pone.0050315

PMC ID: 3527463

PubMed ID: 23284636

SO-VID: 8440f461-92a6-4ee8-ab0c-5747001b1e39

License:

This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

History

Date received : 20 July 2012

Date accepted : 17 October 2012

Page count

Pages: 9

Funding

This study has been funded by the Alliance for Health Policy and Systems Research (AHPSR: http://www.who.int/alliance-hpsr/en/) to LH as Principal Investigator from Universidad Peruana Cayetano Heredia (TSA No. PO200090444). JJM, FDC (Investigators) and LH (Member of Consultative Board) are affiliated with CRONICAS Centre of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia which is funded by the National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract No. HHSN268200900033C. Participation of AGL was funded by the program 2D43 TW000393 “Peruvian Consortium of Training in Infectious Diseases” awarded to NAMRU-6 by the Fogarty International Center of the National Institutes of Health of the United States of America. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Job Preferences of Nurses and Midwives for Taking Up a Rural Job in Peru: A Discrete Choice Experiment

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Abstract

Background

Methods and Findings

Conclusions

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PLOS Global Public Health

Most cited references 12

A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas.

Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment

Labeled versus unlabeled discrete choice experiments in health economics: an application to colorectal cancer screening.

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