Yaya Bocoum Fadima, Koné Eddine, Kouanda Seni, Yaméogo W Maurice E, Bado Aristide Romaric
Hum Resour Health. 2014;12 Suppl 1(Suppl 1):S7. doi: 10.1186/1478-4491-12-S1-S7. Epub 2014 May 12.
The lack of motivation of health workers to practice in rural areas remains a crucial problem for decision-makers, as it deprives the majority of access to health care. To solve the problem, many countries have implemented health worker retention strategies. However, the development of such strategies requires an understanding of the preferences of health workers. The objective of the study was to identify a package for attracting and retaining health workers in underserved areas.
A cross sectional study was conducted in three health regions of Burkina Faso in 2012. A discrete choice experiment was used to investigate preferences for incentive packages among health workers recruited under the regionalized policy. In-depth interviews and focus group discussions with health workers currently working in the East and Sahel regions and policy makers, and a literature review on attraction and retention in low income countries, were performed to identify the attributes and levels. These attributes were: the regionalized recruitment policy, health insurance, work equipment, housing, and specific incentive compensation. The final design resulted in 16 choice sets. A multinomial logistic regression was used to determine the influence of socio-demographic characteristics on choice of a given option. A probit logistic regression model was then used to analyze the effect of these difference variables on choice, to identify the incentive package best suited to health workers. In total, questionnaires were administered to 315 regional health workers.
For all participants, choice of package was strongly influenced by length of commitment under the policy and provision of housing. Sex, number of years in profession, and location also influenced the choice of package. Women are twice more likely to choose a package with free housing and the cancellation of the policy.
It is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas. In addition, the methodology of discrete choice experiment has been particularly useful, not only for better understanding the factors explaining the reluctance of health workers to work in underserved areas, but also to provide practical advice to the government, to improve its retention policy.
卫生工作者缺乏在农村地区执业的积极性，这对决策者来说仍是一个关键问题，因为这使大多数人无法获得医疗保健服务。为解决这一问题，许多国家实施了卫生工作者留用策略。然而，制定此类策略需要了解卫生工作者的偏好。本研究的目的是确定一套吸引和留住服务欠缺地区卫生工作者的方案。
2012年在布基纳法索的三个卫生区域进行了一项横断面研究。采用离散选择实验来调查根据区域化政策招聘的卫生工作者对激励方案的偏好。对目前在东部和萨赫勒地区工作的卫生工作者以及政策制定者进行了深入访谈和焦点小组讨论，并对低收入国家的吸引和留用情况进行了文献综述，以确定属性和水平。这些属性包括：区域化招聘政策、健康保险、工作设备、住房以及特定的激励性薪酬。最终设计产生了16个选择集。使用多项逻辑回归来确定社会人口特征对给定选项选择的影响。然后使用概率逻辑回归模型来分析这些差异变量对选择的影响，以确定最适合卫生工作者的激励方案。总共向315名区域卫生工作者发放了问卷。
对于所有参与者来说，方案的选择受到政策规定的服务期限和住房提供情况的强烈影响。性别、工作年限和工作地点也影响方案的选择。女性选择提供免费住房且取消该政策的方案的可能性是男性的两倍。
政府在制定解决服务欠缺地区卫生工作者吸引和留用问题的政策时，考虑卫生工作者的偏好非常重要。此外，离散选择实验方法特别有用，不仅有助于更好地理解解释卫生工作者不愿在服务欠缺地区工作的因素，还能为政府提供实用建议，以改进其留用政策。
