How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India
India faces significant challenges in attracting qualified health workers to rural areas. In 2010 the authors conducted a Discrete Choice Experiment (DCE) in the Indian states of Uttarakhand and Andhra Pradesh to understand what health departments...
| Main Authors: | , , , , , , , , , |
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| Format: | Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2013
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2012/08/17380242/attract-health-workers-rural-areas-findings-discrete-choice-experiment-india http://hdl.handle.net/10986/13575 |
| Summary: | India faces significant challenges in
attracting qualified health workers to rural areas. In 2010
the authors conducted a Discrete Choice Experiment (DCE) in
the Indian states of Uttarakhand and Andhra Pradesh to
understand what health departments in India could do to make
rural service more attractive for doctors and nurses.
Specifically, we wanted to do the following: (a) examine the
effect of monetary and nonmonetary job attributes on health
worker job choices; and (b) develop incentive
'packages' with a focus on jobs in rural areas.
The study sample included medical students, nursing
students, in-service doctors and nurses at primary health
centers. An initial qualitative study identified eight job
attributes health center type, area, health facility
infrastructure, staff and workload, salary, guaranteed
transfer to city or town after some years of service,
professional development, and job in native area.
Respondents were required to choose between a series of
hypothetical job pairs that were characterized by different
attribute-level combinations. Bivariate probit and mixed
logit regression was used for the statistical analysis of
the choice responses. The findings suggest that the supply
of medical graduates for rural jobs remained inelastic in
the presence of individual monetary and nonmonetary
incentives. In contrast, the supply of nursing students for
rural jobs was elastic. Further, medical and nursing
students from rural areas had a greater inclination to take
up rural jobs. The supply of in-service doctors and nurses
for rural posts was elastic. Higher salary and easier
enrolment in higher education programs in lieu of some years
of rural service emerged as the most powerful driver of job
choice. Overall, better salary, good facility
infrastructure, and easier enrolment in higher education
programs appear to be the most effective drivers of uptake
of rural posts for students and in-service workers.
Combining these incentives can substantially increase rural
recruitment. Incentivizing medical graduates to take up
rural service appears to be challenging in India's
context. This can be improved to some extent by offering
easier admission to specialist training and recruiting
students from rural backgrounds. In contrast, nursing
students and in-services nurses are much more receptive to
incentives for uptake of rural service. This suggests that
cadres such as nurse practitioners can play an important
role in delivering primary care services in rural India. |
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