Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
BMC Health Serv Res. 2012 Jul 23;12:212. doi: 10.1186/1472-6963-12-212.
Health facilities require teams of health workers with complementary skills and responsibilities to efficiently provide quality care. In low-income countries, failure to attract and retain health workers in rural areas reduces population access to health services and undermines facility performance, resulting in poor health outcomes. It is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas.
We investigated preferences for job characteristics among final year medical, nursing, pharmacy, and laboratory students at select universities in Uganda. Participants were administered a cadre-specific discrete choice experiment that elicited preferences for attributes of potential job postings they were likely to pursue after graduation. Job attributes included salary, facility quality, housing, length of commitment, manager support, training tuition, and dual practice opportunities. Mixed logit models were used to estimate stated preferences for these attributes.
Data were collected from 246 medical students, 132 nursing students, 50 pharmacy students and 57 laboratory students. For all student-groups, choice of job posting was strongly influenced by salary, facility quality and manager support, relative to other attributes. For medical and laboratory students, tuition support for future training was also important, while pharmacy students valued opportunities for dual practice.
In Uganda, financial and non-financial incentives may be effective in attracting health workers to underserved areas. Our findings contribute to mounting evidence that salary is not the only important factor health workers consider when deciding where to work. Better quality facilities and supportive managers were important to all students. Similarities in preferences for these factors suggest that team-based, facility-level strategies for attracting health workers may be appropriate. Improving facility quality and training managers to be more supportive of facility staff may be particularly cost-effective, as investments are borne once while benefits accrue to a range of health workers at the facility.
医疗机构需要具有互补技能和职责的医疗团队，以高效地提供优质护理。在低收入国家，未能吸引和留住农村地区的卫生工作者，会减少人们获得卫生服务的机会，并破坏设施的绩效，导致健康状况不佳。政府在制定吸引和留住服务不足地区卫生工作者的政策时，考虑卫生工作者的偏好是很重要的。
我们调查了乌干达几所大学的医学、护理、药学和实验室专业的应届毕业生对工作特征的偏好。参与者接受了特定干部的离散选择实验，该实验引出了他们对毕业后可能从事的潜在工作岗位的属性偏好。工作属性包括工资、设施质量、住房、承诺期限、经理支持、培训学费和双重实践机会。使用混合对数模型来估计这些属性的偏好。
从 246 名医学生、132 名护理学生、50 名药学学生和 57 名实验室学生中收集了数据。对于所有学生群体，工作岗位的选择都强烈受到工资、设施质量和经理支持的影响，而其他属性的影响相对较小。对于医学和实验室学生来说，未来培训的学费支持也很重要，而药学学生则重视双重实践的机会。
在乌干达，财务和非财务激励措施可能会有效地吸引卫生工作者到服务不足的地区。我们的研究结果为越来越多的证据做出了贡献，即工资并不是卫生工作者决定工作地点时唯一重要的因素。更好的设施质量和支持性的经理对所有学生都很重要。对这些因素的偏好相似表明，以团队为基础、以设施为基础的吸引卫生工作者的策略可能是合适的。改善设施质量和培训经理以更好地支持设施工作人员可能特别具有成本效益，因为投资只需一次，而收益则会在设施内的一系列卫生工作者中产生。
