Health Systems Science, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
Institute for Global Health, University College London, London, UK.
BMJ Glob Health. 2021 Jul;6(7). doi: 10.1136/bmjgh-2021-006001.
Doctor absenteeism is widespread in Bangladesh, and the perspectives of the actors involved are insufficiently understood. This paper sought to elicit preferences of doctors over aspects of jobs in rural areas in Bangladesh that can help to inform the development of packages of policy interventions that may persuade them to stay at their posts.
We conducted a discrete choice experiment with 308 doctors across four hospitals in Dhaka, Bangladesh. Four attributes of rural postings were included based on a literature review, qualitative research and a consensus-building workshop with policymakers and key health-system stakeholders: relationship with the community, security measures, attendance-based policies and incentive payments. Respondents' choices were analysed with mixed multinomial logistic and latent class models and were used to simulate the likely uptake of jobs under different policy packages.
All attributes significantly impacted doctor choices (p<0.01). Doctors strongly preferred jobs at rural facilities where there was a supportive relationship with the community (β=0.93), considered good attendance in education and training (0.77) or promotion decisions (0.67), with functional security (0.67) and higher incentive payments (0.5 per 10% increase of base salary). Jobs with disciplinary action for poor attendance were disliked by respondents (-0.63). Latent class analysis identified three groups of doctors who differed in their uptake of jobs. Scenario modelling identified intervention packages that differentially impacted doctor behaviour and combinations that could feasibly improve doctors' attendance.
Bangladeshi doctors have strong but varied preferences over interventions to overcome absenteeism. We generated evidence suggesting that interventions considering the perspective of the doctors themselves could result in substantial reductions in absenteeism. Designing policy packages that take account of the different situations facing doctors could begin to improve their ability and motivation to be present at their job and generate sustainable solutions to absenteeism in rural Bangladesh.
在孟加拉国，医生缺勤现象普遍存在，而对相关利益方的观点了解不足。本文旨在了解医生对孟加拉国农村地区工作的偏好，以帮助制定一系列政策干预措施，从而吸引他们留在岗位上。
我们在孟加拉国达卡的四家医院对 308 名医生进行了离散选择实验。根据文献回顾、定性研究和与政策制定者及主要卫生系统利益相关者的共识建设研讨会，确定了农村岗位的四个属性，包括与社区的关系、安全措施、考勤政策和激励性薪酬。使用混合多项逻辑回归和潜在类别模型对受访者的选择进行分析，并根据不同政策方案模拟工作的可能参与情况。
所有属性都对医生的选择产生了显著影响（p<0.01）。医生强烈倾向于在与社区关系融洽的农村医疗机构工作（β=0.93），认为在教育和培训（0.77）或晋升决策（0.67）中出勤率高、有功能性安全（0.67）和更高的激励性薪酬（基础工资每增加 10%，薪酬增加 0.5）。对缺勤行为有纪律处分的工作则不受受访者欢迎（-0.63）。潜在类别分析确定了在工作参与方面存在差异的三组医生。情景建模确定了可能对医生行为产生不同影响的干预方案，以及能够切实提高医生出勤率的组合。
孟加拉国医生对克服缺勤现象的干预措施有强烈但不同的偏好。我们提供的证据表明，考虑到医生自身观点的干预措施可能会导致缺勤率大幅降低。设计考虑到医生面临的不同情况的政策方案，可以开始提高他们在工作中的能力和积极性，并为孟加拉国农村地区的可持续缺勤解决方案提供帮助。
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