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...
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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 |
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okr-10986-13575 |
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| recordtype |
oai_dc |
| repository_type |
Digital Repository |
| institution_category |
Foreign Institution |
| institution |
Digital Repositories |
| building |
World Bank Open Knowledge Repository |
| collection |
World Bank |
| language |
English en_US |
| topic |
BASIC HEALTH SERVICES CAREER CAREER PROSPECTS CITIZENS COLLEGES COMMUNITY HEALTH COST EFFECTIVENESS DEGREES DENTISTS DEVELOPING COUNTRIES DOCTOR DRINKING WATER DRUGS EDUCATION DEPARTMENT EDUCATIONAL OPPORTUNITIES EMPLOYMENT EMPLOYMENT OPPORTUNITIES FAMILY WELFARE FEMALE FEMALE STUDENTS GLOBAL HEALTH GOVERNMENT INITIATIVES GYNECOLOGY HEALTH CARE FACILITIES HEALTH CARE PROVIDERS HEALTH CENTERS HEALTH ECONOMICS HEALTH FACILITIES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEM HEALTH WORKERS HEALTH WORKFORCE HIGHER EDUCATION HIGHER EDUCATION PROGRAMS HOMEOPATHY HOSPITAL HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES IMPACT ON HEALTH IMPORTANT POLICY INCOME INDEXES INSERVICE TRAINING JOB MARKET LITERATURE LIVING CONDITIONS MARITAL STATUS MEDICAL COLLEGE MEDICAL COLLEGES MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL PROFESSIONALS MEDICAL SCHOOL MEDICAL SCIENCES MEDICAL STUDENTS MEDICINE MEDICINES MIDWIFE MIDWIFERY MIDWIVES MINISTRY OF HEALTH NURSE NURSES NURSING NURSING SCHOOLS NURSING STUDENTS NUTRITION NUTRITIONISTS PAPERS PATIENTS PEDIATRICS PEER REVIEW PERSONAL DEVELOPMENT PHARMACISTS PHYSICIAN PHYSICIANS PHYSIOTHERAPISTS POLICY GUIDANCE POLICY MAKERS POOR HEALTH POSTGRADUATE STUDIES PRACTITIONERS PREFERENTIAL ADMISSION PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE FACILITIES PRIVATE COLLEGES PROBABILITY PROFESSIONAL DEVELOPMENT PUBLIC HEALTH QUALITY SERVICES RESOURCE ALLOCATION RURAL AREAS SCHOOL STUDENTS SEX SKILL DEVELOPMENT SOCIOECONOMIC STATUS SPECIALIST SPECIALISTS SPOUSES STUDENT GROUP SURGERY URBAN AREAS URBAN CENTER WORK ENVIRONMENT WORKERS WORKING CONDITIONS WORKPLACE |
| spellingShingle |
BASIC HEALTH SERVICES CAREER CAREER PROSPECTS CITIZENS COLLEGES COMMUNITY HEALTH COST EFFECTIVENESS DEGREES DENTISTS DEVELOPING COUNTRIES DOCTOR DRINKING WATER DRUGS EDUCATION DEPARTMENT EDUCATIONAL OPPORTUNITIES EMPLOYMENT EMPLOYMENT OPPORTUNITIES FAMILY WELFARE FEMALE FEMALE STUDENTS GLOBAL HEALTH GOVERNMENT INITIATIVES GYNECOLOGY HEALTH CARE FACILITIES HEALTH CARE PROVIDERS HEALTH CENTERS HEALTH ECONOMICS HEALTH FACILITIES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEM HEALTH WORKERS HEALTH WORKFORCE HIGHER EDUCATION HIGHER EDUCATION PROGRAMS HOMEOPATHY HOSPITAL HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES IMPACT ON HEALTH IMPORTANT POLICY INCOME INDEXES INSERVICE TRAINING JOB MARKET LITERATURE LIVING CONDITIONS MARITAL STATUS MEDICAL COLLEGE MEDICAL COLLEGES MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL PROFESSIONALS MEDICAL SCHOOL MEDICAL SCIENCES MEDICAL STUDENTS MEDICINE MEDICINES MIDWIFE MIDWIFERY MIDWIVES MINISTRY OF HEALTH NURSE NURSES NURSING NURSING SCHOOLS NURSING STUDENTS NUTRITION NUTRITIONISTS PAPERS PATIENTS PEDIATRICS PEER REVIEW PERSONAL DEVELOPMENT PHARMACISTS PHYSICIAN PHYSICIANS PHYSIOTHERAPISTS POLICY GUIDANCE POLICY MAKERS POOR HEALTH POSTGRADUATE STUDIES PRACTITIONERS PREFERENTIAL ADMISSION PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE FACILITIES PRIVATE COLLEGES PROBABILITY PROFESSIONAL DEVELOPMENT PUBLIC HEALTH QUALITY SERVICES RESOURCE ALLOCATION RURAL AREAS SCHOOL STUDENTS SEX SKILL DEVELOPMENT SOCIOECONOMIC STATUS SPECIALIST SPECIALISTS SPOUSES STUDENT GROUP SURGERY URBAN AREAS URBAN CENTER WORK ENVIRONMENT WORKERS WORKING CONDITIONS WORKPLACE Rao, Krishna D. Shroff, Zubin Ramani, Sudha Khandpur, Neha Murthy, Seema Hazarika, Indrajit Choksi, Maulik Ryan, Mandy Berman, Berman Vujicic, Marko How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India |
| geographic_facet |
South Asia India |
| relation |
Health, Nutrition and Population (HNP)
discussion paper; |
| description |
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. |
| format |
Publications & Research :: Working Paper |
| author |
Rao, Krishna D. Shroff, Zubin Ramani, Sudha Khandpur, Neha Murthy, Seema Hazarika, Indrajit Choksi, Maulik Ryan, Mandy Berman, Berman Vujicic, Marko |
| author_facet |
Rao, Krishna D. Shroff, Zubin Ramani, Sudha Khandpur, Neha Murthy, Seema Hazarika, Indrajit Choksi, Maulik Ryan, Mandy Berman, Berman Vujicic, Marko |
| author_sort |
Rao, Krishna D. |
| title |
How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India |
| title_short |
How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India |
| title_full |
How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India |
| title_fullStr |
How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India |
| title_full_unstemmed |
How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India |
| title_sort |
how to attract health workers to rural areas? findings from a discrete choice experiment from india |
| publisher |
World Bank, Washington, DC |
| publishDate |
2013 |
| url |
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 |
| _version_ |
1764423781724454912 |
| spelling |
okr-10986-135752021-04-23T14:03:08Z How to Attract Health Workers to Rural Areas? Findings from a Discrete Choice Experiment from India Rao, Krishna D. Shroff, Zubin Ramani, Sudha Khandpur, Neha Murthy, Seema Hazarika, Indrajit Choksi, Maulik Ryan, Mandy Berman, Berman Vujicic, Marko BASIC HEALTH SERVICES CAREER CAREER PROSPECTS CITIZENS COLLEGES COMMUNITY HEALTH COST EFFECTIVENESS DEGREES DENTISTS DEVELOPING COUNTRIES DOCTOR DRINKING WATER DRUGS EDUCATION DEPARTMENT EDUCATIONAL OPPORTUNITIES EMPLOYMENT EMPLOYMENT OPPORTUNITIES FAMILY WELFARE FEMALE FEMALE STUDENTS GLOBAL HEALTH GOVERNMENT INITIATIVES GYNECOLOGY HEALTH CARE FACILITIES HEALTH CARE PROVIDERS HEALTH CENTERS HEALTH ECONOMICS HEALTH FACILITIES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEM HEALTH WORKERS HEALTH WORKFORCE HIGHER EDUCATION HIGHER EDUCATION PROGRAMS HOMEOPATHY HOSPITAL HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES IMPACT ON HEALTH IMPORTANT POLICY INCOME INDEXES INSERVICE TRAINING JOB MARKET LITERATURE LIVING CONDITIONS MARITAL STATUS MEDICAL COLLEGE MEDICAL COLLEGES MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL PROFESSIONALS MEDICAL SCHOOL MEDICAL SCIENCES MEDICAL STUDENTS MEDICINE MEDICINES MIDWIFE MIDWIFERY MIDWIVES MINISTRY OF HEALTH NURSE NURSES NURSING NURSING SCHOOLS NURSING STUDENTS NUTRITION NUTRITIONISTS PAPERS PATIENTS PEDIATRICS PEER REVIEW PERSONAL DEVELOPMENT PHARMACISTS PHYSICIAN PHYSICIANS PHYSIOTHERAPISTS POLICY GUIDANCE POLICY MAKERS POOR HEALTH POSTGRADUATE STUDIES PRACTITIONERS PREFERENTIAL ADMISSION PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE FACILITIES PRIVATE COLLEGES PROBABILITY PROFESSIONAL DEVELOPMENT PUBLIC HEALTH QUALITY SERVICES RESOURCE ALLOCATION RURAL AREAS SCHOOL STUDENTS SEX SKILL DEVELOPMENT SOCIOECONOMIC STATUS SPECIALIST SPECIALISTS SPOUSES STUDENT GROUP SURGERY URBAN AREAS URBAN CENTER WORK ENVIRONMENT WORKERS WORKING CONDITIONS WORKPLACE 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. 2013-05-28T19:28:32Z 2013-05-28T19:28:32Z 2012-08 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 English en_US Health, Nutrition and Population (HNP) discussion paper; CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank World Bank, Washington, DC Publications & Research :: Working Paper Publications & Research South Asia India |