Researching interventions to address the human resources for health crisis - an application of discrete choice experiments in Kenya, Thailand and South Africa
RESEARCHING INTERVENTIONS TO ADDRESS THE HUMAN RESOURCES FOR HEALTH CRISIS – AN APPLICATION OF DISCRETE CHOICE EXPERIMENTS IN KENYA, THAILAND AND SOUTH AFRICA
Identifying policies to improve nurse recruitment and retention in rural Kenya: Results of a discrete choice experiment Sandra Mudhune, Kethi Mullei, Jackline Wafula, Mike English, Catherine Goodman, Mylene Lagarde, Duane Blaauw
NURSES WORKING IN HEALTH SYSTEMS MATERNAL MORTALITY
Background <ul><li>Shortage of HW contributes directly or indirectly to increased inequalities of access to basic health care and therefore health outcomes </li></ul><ul><li>Two major contextual issues in Kenya: </li></ul><ul><ul><li>Short term solutions have been found to the nursing recruitment </li></ul></ul><ul><ul><li>Observation that government employed nurses frequently seek transfers from rural to urban posts soon after their employment </li></ul></ul>
Objectives <ul><li>Set out to explore what package of policy-relevant incentives might need to be provided to registered nurses to encourage them to accept and remain in rural posts </li></ul>
Methods <ul><li>Used DCE to model relative importance of different job characteristics and the impact of different policy interventions. </li></ul><ul><li>Utilised a labelled choice experiment -choice was driven by two factors. </li></ul><ul><ul><li>A labelled design allows more flexibility in the design, allows for the definition of alternative-specific levels. </li></ul></ul><ul><ul><li>It was felt that the labels would appear less artificial than the usual generic headings (“job A” or “job B”). </li></ul></ul><ul><li>Study done among a sample of nursing graduates (and doctors in one country) </li></ul>
Methods <ul><li>Attribute selection </li></ul><ul><li>- policy options, KII, FGDs </li></ul><ul><li>In addition to the DCE each interviewee completed SAQ covering individual characteristics, views on work in rural areas, sense of vocation and values, job preferences and intentions on graduation. </li></ul>
Choice Experiment Design Labelled choice experiment 6 types of incentives in rural posts
Discussion <ul><li>Geo-imbalance and pseudo shortage – many nurses, they are just not willing to take up rural posts. What can keep them there? </li></ul><ul><li>The job attributes that seem that they might be directly influenced by health policy to potentially increase the attraction of rural postings are </li></ul><ul><li>Permanent contracts which can be tagged to rural posts. Important findings as fixed term contracts that have been funded over the past few years by donors come to an end. </li></ul><ul><li>Allowances for rural postings </li></ul><ul><li>Providing opportunity for training, and </li></ul><ul><li>Reducing the years of experience before gaining a promotion. </li></ul>
HR plays a critical role in any attempt to improve health outcome The world redrawn according to the presence of nurses in health systems (for the map on top) and redrawn according to maternal mortality – this juxtaposition of maps illustrates one of the issues of the HR global crisis, which is the shortage of nurses where they are needed the most.
This shortage of HW is particularly seen in virtually all countries in rural areas. In Kenya the nursing HR crisis is of particular importance and over the years only short terms solutions have been found to solve this issue
Work is part of a larger study exploring RNs employment preferences
one of the objectives of the study was to test the effects of potential policies to attract nurses to rural areas, we wanted to be able to have job characteristics that were different for rural and urban positions.
Policy options identified as successful in promoting rural recruitment or retention from lit reviews or HR policy docs KII used to identify feasible local strategies FGDs used with nurses to make sure attributes and levels were relevant
Focused on RN students in their final year of which we have two types: pre-service students who have no work experience and are 1 st time college students Distance learners who are ENs seeking to upgrade to RNs and have upto 10 years worth of work experience
Focusing on the ORs for rural jobs so urban ORs are not represented here All job attributes were found to significantly influence the utility associated with a job, except type of facility, housing and management style in the DL All coefficients estimated were in the expected direction.. That is the better the working conditions, the greater the utility associated with the job, either in a rural or urban area.
The base case is a rural posting in a hospital, with a salary of USD 228, a single room provided, a 3 year contract, no guaranteed further training, personal management style and a guaranteed promotion after 4 years. Each bar represents what effect of the improved attribute has on the uptake of a rural post.