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Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment Translated title: Comment attirer le personnel infirmier dans les zones rurales?: Résultats d'une expérience à choix discrets réalisée dans plusieurs pays Translated title: Intervenciones de política para atraer a las enfermeras a las zonas rurales: modelo de elección discreta multinacional

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      Abstract

      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.

      Translated abstract

      OBJECTIF: Comparer l'efficacité de différentes politiques visant à attirer le personnel infirmier dans les zones rurales au Kenya, en Afrique du Sud et en Thaïlande, en utilisant les données d'une expérience à choix discrets. MÉTHODES: Une expérience à choix discrets a été conçue pour modéliser l'efficacité d'incitations financières et non financières visant à attirer le personnel infirmier dans les zones rurales. Dans chaque pays, des données ont été collectées auprès de 300 élèves infirmiers en fin d'études, puis analysées avec des modèles logit mixtes afin de prédire l'acceptation de postes en milieu rural en fonction de différentes combinaisons de mesures incitatives. RÉSULTATS: Les préférences du personnel infirmier pour diverses interventions de réaffectation des ressources différaient significativement entre les trois pays. Au Kenya et en Afrique du Sud, des possibilités plus intéressantes sur le plan éducatif ou des primes de ruralité seraient les incitations les plus efficaces pour améliorer le recrutement de personnel en milieu rural, tandis qu'en Thaïlande, c'est une meilleure couverture parl'assurance maladie qui aurait le plus d'impact. CONCLUSION: Des expériences à choix discrets peuvent être conçues pour aider les décideurs politiques à définir les interventions les plus efficaces pour remédier aux pénuries de personnel dans les zones rurales. Des interventions adaptées aux conditions locales seront probablement plus efficaces que des approches standardisées, définies au niveau mondial.

      Translated abstract

      OBJETIVO: Evaluar la eficacia relativa de diferentes políticas para atraer a las enfermeras a zonas rurales en Kenya, Sudáfrica y Tailandia utilizando los datos obtenidos mediante un modelo de elección discreta (MED). MÉTODOS: Se diseñó un MED con etiquetas para modelizar la eficacia relativa de la aplicación de estrategias financieras y no financieras para atraer a las enfermeras a las zonas rurales. Se recogieron datos de más de 300 estudiantes de enfermería al término de la carrera en cada país, y se aplicaron modelos logit mixtos para analizar y predecir la ocupación de los puestos rurales en respuesta a distintas combinaciones de incentivos. RESULTADOS: Las preferencias de las enfermeras ante diferentes intervenciones en materia de recursos humanos difirieron significativamente entre los tres países. En Kenya y Sudáfrica, unas mejores oportunidades educativas o la instauración de subsidios rurales serían la fórmula más eficaz para aumentar la ocupación de los puestos rurales, mientras que en Tailandia se conseguiría el máximo impacto ampliando la cobertura del seguro de enfermedad. CONCLUSIÓN: Es posible diseñar MED que ayuden a las autoridades a elegir las intervenciones más eficaces para hacer frente a la escasez de personal en las zonas rurales. Los paquetes de intervenciones adaptados a las condiciones locales tienen más probabilidades de ser eficaces que los enfoques mundiales normalizados.

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      Tests of Equality Between Sets of Coefficients in Two Linear Regressions

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        Motivation and retention of health workers in developing countries: a systematic review

        Background A key constraint to achieving the MDGs is the absence of a properly trained and motivated workforce. Loss of clinical staff from low and middle-income countries is crippling already fragile health care systems. Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and non-financial incentives on motivation and retention. Methods Four literature databases were searched together with Google Scholar and 'Human Resources for Health' on-line journal. Grey literature studies and informational papers were also captured. The inclusion criteria were: 1) article stated clear reasons for implementing specific motivations to improve health worker motivation and/or reduce medical migration, 2) the intervention recommended can be linked to motivation and 3) the study was conducted in a developing country and 4) the study used primary data. Results Twenty articles met the inclusion criteria. They consisted of a mixture of qualitative and quantitative studies. Seven major motivational themes were identified: financial rewards, career development, continuing education, hospital infrastructure, resource availability, hospital management and recognition/appreciation. There was some evidence to suggest that the use of initiatives to improve motivation had been effective in helping retention. There is less clear evidence on the differential response of different cadres. Conclusion While motivational factors are undoubtedly country specific, financial incentives, career development and management issues are core factors. Nevertheless, financial incentives alone are not enough to motivate health workers. It is clear that recognition is highly influential in health worker motivation and that adequate resources and appropriate infrastructure can improve morale significantly.
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          Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention

          Background Many countries in middle- and low-income countries today suffer from severe staff shortages and/or maldistribution of health personnel which has been aggravated more recently by the disintegration of health systems in low-income countries and by the global policy environment. One of the most damaging effects of severely weakened and under-resourced health systems is the difficulty they face in producing, recruiting, and retaining health professionals, particularly in remote areas. Low wages, poor working conditions, lack of supervision, lack of equipment and infrastructure as well as HIV and AIDS, all contribute to the flight of health care personnel from remote areas. In this global context of accelerating inequities health service policy makers and managers are searching for ways to improve the attraction and retention of staff in remote areas. But the development of appropriate strategies first requires an understanding of the factors which influence decisions to accept and/or stay in a remote post, particularly in the context of mid and low income countries (MLICS), and which strategies to improve attraction and retention are therefore likely to be successful. It is the aim of this review article to explore the links between attraction and retention factors and strategies, with a particular focus on the organisational diversity and location of decision-making. Methods This is a narrative literature review which took an iterative approach to finding relevant literature. It focused on English-language material published between 1997 and 2007. The authors conducted Pubmed searches using a range of different search terms relating to attraction and retention of staff in remote areas. Furthermore, a number of relevant journals as well as unpublished literature were systematically searched. While the initial search included articles from high- middle- and low-income countries, the review focuses on middle- and low-income countries. About 600 papers were initially assessed and 55 eventually included in the review. Results The authors argue that, although factors are multi-facetted and complex, strategies are usually not comprehensive and often limited to addressing a single or limited number of factors. They suggest that because of the complex interaction of factors impacting on attraction and retention, there is a strong argument to be made for bundles of interventions which include attention to living environments, working conditions and environments and development opportunities. They further explore the organisational location of decision-making related to retention issues and suggest that because promising strategies often lie beyond the scope of human resource directorates or ministries of health, planning and decision-making to improve retention requires multi-sectoral collaboration within and beyond government. The paper provides a simple framework for bringing the key decision-makers together to identify factors and develop multi-facetted comprehensive strategies. Conclusion There are no set answers to the problem of attraction and retention. It is only through learning about what works in terms of fit between problem analysis and strategy and effective navigation through the politics of implementation that any headway will be made against the almost universal challenge of staffing health service in remote rural areas.
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            Author and article information

            Affiliations
            [1 ] University of Witwatersrand South Africa
            [2 ] International Health Policy Program Thailand
            [3 ] Kenya Medical Research Institute Kenya
            [4 ] London School of Hygiene and Tropical Medicine United Kingdom
            Contributors
            Role: ND
            Role: ND
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            Journal
            bwho
            Bulletin of the World Health Organization
            Bull World Health Organ
            World Health Organization (Genebra )
            0042-9686
            May 2010
            : 88
            : 5
            : 350-356
            S0042-96862010000500012

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Public Health
            Categories
            Health Policy & Services

            Public health

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