Work Preferences in Rural Health Job Posting Among Medical Interns in a Lower Middle-Income Country— a Discrete Choice Experiment

Julius R. Migriño

Abstract


Introduction: Timely empirical evidence is important in the success of health systems, and such evidence is necessary for informed policy making to address inequity in the health workforce. Literature is ripe with incentives that affect recruitment and retention of physicians in rural and remote areas, but such data in still lacking in the Philippine setting. Discrete choice experiment is one methodology utilized by the World Health Organization which provides both qualitative and quantitative information to aid policy makers in health human resource management.

Methods: The study utilized a discrete choice experiment involving three phases: 1) identification of incentives and levels using key informant interviews and focus group discussions, 2) selection of scenarios utilizing an experimental design, and 3) administration of survey based on WHO guidelines. Conditional logistic regression, point estimates, and correlational analyses were done using Stata.

Results: There is significant association between type of background and considerations for rural practice among the respondents based on Pearson’s correlation (p < 0.01). The respondents put more value into non-wage rural job posting incentives than small to modest base salary increases. The high willingness to pay for the presence of supervision, relative location of work areas from families, and status of workplace infrastructure/equipment or supplies suggest the importance of workplace conditions to attract rural health physicians. Combinations of wage and non-wage incentives may be necessary to provide for the most cost-efficient increases in rural job post uptake rates based on post-estimate calculations.

Conclusion: Philippine medical interns and young doctors value non-wage incentives in considering rural health job postings. Rural health job postings with these incentives are predicted to significantly increase recruitment in rural health job posts, particularly when combinations of wage and high-impact non-wage incentives are considered.


Keywords


Global health; Rural job posting; Health human resources; Health systems; Recruitment; Preferences

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References


Diallo K, Zurn P, Gupta N, Dal Poz M. Monitoring and evaluation of human resources for health: an international perspective. Hum Resour Health. 2003;1(1):3. doi:10.1186/1478-4491-1-3.

WHO. WHO | The World Health Report 2006 - working together for health. https://www.who.int/whr/2006/en/. Accessed July 29, 2020.

Badr E, Mohamed NA, Afzal MM, Bile KM. Strengthening human resources for health through information, coordination and accountability mechanisms: the case of the Sudan. Bull World Health Organ. 2013;91(11):868–73. doi:10.2471/BLT.13.118950.

Packer C, Labonte R, Spitzer D. WHO Commission on Social Determinants of Health: Globalization and Health Worker Crisis. Globalization Knowledge Network. http://www.who.int/social_determinants/resources/gkn_packer_al.pdf. Published 2007. Accessed July 29, 2020.

WHO. Global strategy on human resources for health: Workforce 2030. World Health Organization. https://www.who.int/hrh/resources/global_strategy_workforce2030_14_print.pdf. Published 2016. Accessed July 29, 2020.

Romualdez A, dela Rosa JF, Flavier JD, et al. The Philippines Health System Review. Manila, Philippines: World Health Organization, Western Pacific Region. http://www.searo.who.int/entity/asia_pacific_observatory/publications/hits/hit_philippines/en/. Published 2011. Accessed July 29, 2020.

WHO, DOH. Health Service Delivery Profile - Philippines 2012. http://www.wpro.who.int/health_services/service_delivery_profile_philippines.pdf. Published 2012.

Philippine Statistics Authority. PSA- i-MDGs-Table: Infant Mortality Rate by Region and Year. http://nap.psa.gov.ph/iMDGs/PX/Dialog/varval.asp?ma=4bvinimr&ti=Infant+Mortality+Rate+by+Region+and+Year%2E+&path=../Database/NSCB/Goals/Goal4/〈=1&unit=Index. Accessed 2019 Jan 12.

Kruk ME, Johnson JC, Gyakobo M, et al. Rural practice preferences among medical students in Ghana: a discrete choice experiment. Bull World Health Organ. 2010;88(5):333–41. doi:10.2471/BLT.09.072892

Ronquillo K, Elegado-Lorenzo F, Nodora R. Human Resources for Health Migration in the Philippines: A Case Study and Policy Directions. ASEAN Learning Network for Human Resources for Health. 2005;August 2-5.

Institute of Health Policy and Development Studies. Migration of health workers: Country case study Philippines. http://www.ilo.org/sector/Resources/publications/WCMS_161163/lang--en/index.htm . Published 2005. Accessed July 29, 2020.

APMCFI. Vision and Mission | Association of Philippine Medical Colleges Foundation Inc. (APMCFI). Association of Philippine Medical Colleges Foundation, Inc. http://webv2.apmcf-ph.net/apmc_wp/about-apmc/vision-and-mission/. Published 2016. Accessed July 29, 2020.

WHO. How to Conduct a Discrete Choice Experiment for Health Workforce Recruitment and Retention in Remote and Rural Areas: A USER GUIDE WITH CASE STUDIES. World Health Organisation. https://www.who.int/hrh/resources/DCE_UserGuide_WEB.pdf. Published 2012. Accessed July 29, 2020.

Dolea C. Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations. Geneva, Switzerland: World Health Organization; 2010. 72 p.

StackExchange. How to create a nearly orthogonal experimental design in R?. Cross Validated. https://stats.stackexchange.com/questions/110133/how-to-create-a-nearly-orthogonal-experimental-design-in-r. Accessed July 29, 2020.

Reed Johnson F, Lancsar E, Marshall D, et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR Conjoint Analysis Experimental Design Good Research Practices Task Force. Value Health. 2013;16(1):3–13. doi:10.1016/j.val.2012.08.2223

Street DJ, Burgess L, Louviere JJ. Quick and easy choice sets: Constructing optimal and nearly optimal stated choice experiments. International Journal of Research in Marketing. 2005;22(4):459–70. doi:10.1016/j/ijresmar.2005.09.003.

Tang L, Luo X, Cheng Y, Yang F, Ran B. Comparing the State-of-the-Art Efficient Stated Choice Designs Based on Empirical Analysis. Mathematical Problems in Engineering. 2014. doi:10.1155/2014/740612

Atkinson S, Abu el Haj M. Domain analysis for qualitative public health data. Health Policy Plan. 1996;11(4):438–42. doi:10.1093/heapol/11.4.438

Kolstad JR. How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania. Health Econ. 2011;20(2):196–211. doi:10.1002/hec.1581

Smitz M-F, Witter S, Lemiere C, et al. Understanding Health Workers’ Job Preferences to Improve Rural Retention in Timor-Leste: Findings from a Discrete Choice Experiment. PLOS ONE. 2016;11(11). doi:10.1371/journal.pone.0165940

Yun GW, Trumbo CW. Comparative Response to a Survey Executed by Post, E-mail, & Web Form. J Comput Mediat Commun. 2000;6(1). doi:10.1111/j.1083-6101.2000.tb00112.x

Lemiere C. Discrete Choice Experiment (DCE): a Methodology for Eliciting Health Workers’ Preferences. World Health Organization; 2009. Available from: https://www.hrhresourcecenter.org/node/2424.html. Accessed July 29, 2020.

Chan BTB, Degani N, Crichton T, et al. Factors influencing family physicians to enter rural practice: does rural or urban background make a difference?. Can Fam Physician. 2005;51(9):1247. https://pubmed.ncbi.nlm.nih.gov/16926939. Accessed July 29, 2020.

McGrail MR, Humphreys JS, Joyce CM. Nature of association between rural background and practice location: A comparison of general practitioners and specialists. BMC Health Serv Res. 2011;11(1):63. doi:10.1186/1472-6963-11-63

Rodriguez K. Literature Review of Recruitment and Retention for Rural Health Care Providers. Maine AHEC Network. https://www.une.edu/sites/default/files/%281%29%20Rural%20Physician%20Recruitment%20and%20Retention%20Lit%20Review%20FINAL%5B1%5D.pdf. Published 2014. Accessed July 29, 2020.

Serneels P, Montalvo JG, Pettersson G, Lievens T, Butera JD, Kidanu A. Who wants to work in a rural health post? The role of intrinsic motivation, rural background and faith-based institutions in Ethiopia and Rwanda. Bull World Health Organ. 2010;88(5):342–9. doi:10.2471/BLT.09.072728.

Leonardia JA, Prytherch H, Ronquillo K, Nodora RG, Ruppel A. Assessment of factors influencing retention in the Philippine National Rural Physician Deployment Program. BMC Health Serv Res. 2012;12(1):411. doi:10.1186/1472-6963-12-411.

Rana SA, Sarfraz M, Kamran I, Jadoon H. Preferences Of Doctors For Working In Rural Islamabad Capital Territory, Pakistan: A Qualitative Study. J Ayub Med Coll Abbottabad. 2016;28(3):591–596. https://pubmed.ncbi.nlm.nih.gov/28712243. Accessed July 29, 2020.

Lagarde M, Blaauw D. A review of the application and contribution of discrete choice experiments to inform human resources policy interventions. Human Resour Health. 2009;7(1):62. doi:10.1186/1478-4491-7-62.

Rockers PC, Jaskiewicz W, Wurts L, et al. Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment. BMC Health Serv Res. 2012;12:212. doi:10.1186/1472-6963-12-212.

Hanson K, Jack W. Health worker preferences for job attributes in Ethiopia : results from a discrete choice experiment. Washington, D.C: World Bank Group. http://documents.worldbank.org/curated/en/716191468030240068/Health-worker-preferences-for-job-attributes-in-Ethiopia-results-from-a-discrete-choice-experiment. Published April 2008. Accessed July 29, 2020.

Hole AR. Estimation of willingness to pay in preference space vs. WTP space. University of Sheffield. https://www.sheffield.ac.uk/polopoly_fs/1.214046!/file/DCMD.pdf. Published December 8, 2011. Accessed July 29, 2020.

Serneels P, Lindelow M, Montalvo JG, Barr A. For public service or money: understanding geographical imbalances in the health workforce. Health Policy Plan. 2007;22(3):128–38. doi:10.1093/heapol/czm005.




DOI: https://doi.org/10.5195/cajgh.2020.344

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