Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Human Resources for Health
Published in: Human Resources for Health 1/2016

Open Access 01-12-2016 | Research

Job preferences among clinical officers in public sector facilities in rural Kenya: a discrete choice experiment

Authors: Toshio Takemura, Karina Kielmann, Duane Blaauw

Published in: Human Resources for Health | Issue 1/2016

Login to get access

Abstract

Background

Clinical officers (COs), a mid-level cadre of health worker, are the backbone of healthcare provision in rural Kenya. However, the vacancy rate for COs in rural primary healthcare facilities is high. Little is known about factors motivating COs’ preferences for rural postings.

Methods

A discrete choice experiment (DCE) questionnaire was used with 57 COs at public health facilities in nine districts of Nyanza Province, Kenya. The questionnaire was developed on the basis of formative qualitative interviews with COs (n = 5) and examined how five selected job attributes influenced COs’ preferences for working in rural areas. Conditional logit models were employed to examine the relative importance of different job attributes.

Results

Analysis of the qualitative data revealed five important job attributes influencing COs’ preferences: quality of the facility, educational opportunities, housing, monthly salary and promotion. Analysis of the DCE indicated that a 1-year guaranteed study leave after 3 years of service would have the greatest impact on retention, followed by good quality health facility infrastructure and equipment and a 30% salary increase. Sub-group analysis shows that younger COs demonstrated a significantly stronger preference for study leave than older COs. Female COs placed significantly higher value on promotion than male COs.

Conclusions

Although both financial incentives and non-financial incentives were effective in motivating COs to stay in post, the study leave intervention was shown to have the strongest impact on COs’ retention in our study. Further research is required to examine appropriate interventions at each career stage that might boost COs’ professional identity and status but without leading to larger deficits in the availability of generalist COs.
Literature
1.
World Health Organization. Increasing access to health workers in remote and rural areas through improved retention. Geneva: World Health Organization; 2010.
2.
Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007;370:2158–63.CrossRefPubMed
3.
Ministry of Medical Services, Ministry of Public Health and Sanitation. National human resources for health strategic plan (2009–2012). Nairobi, Kenya: Ministry of Medical Services; 2009.
4.
Ndetei D, Khasakhala L, Omolo J: Incentives for health worker retention in Kenya: an assessment of current practice, Discussion Paper Series 62. Harare, Zimbabwe: EQUINET with African Mental Health Foundation, University of Namibia, Training and Research Support Centre, University of Limpopo and ECSA-Regional Health Community; 2008
5.
Ministry of Medical Services, Ministry of Public Health and Sanitation. The Nairobi Communique and Declaration of Commitment. In the First National Human Resources for Health (HRH) Conference in Kenya. Nairobi, Kenya: Ministry of Medical Services, Ministry of Public Health and Sanitation; 2012.
6.
Grobler L, Marais BJ, Mabunda SA, Marindi PN, Reuter H, Volmink J. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Res. 2009;1:CD005.
7.
Lagarde M, Blaauw D. A review of the application and contribution of discrete choice experiments to inform human resources policy interventions. Hum Resour Health. 2009;7:62.CrossRefPubMedPubMedCentral
8.
Mangham LJ, Hanson K, McPake B. How to do (or not to do) … designing a discrete choice experiment for application in a low-income country. Health Policy Plan. 2009;24:151–8.CrossRefPubMed
9.
Ryan M, Kolstad J, Rockers PC, Dolea C. How to conduct a discrete choice experiment for health workforce recruitment and retention in remote and rural areas: a user’s guide for policy makers and researchers. Geneva: World Health Organization, World Bank, and CapacityPlus; 2012.
10.
11.
Dolea C, Stormont L, Braichet J. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bull World Health Organ. 2010;88:379–85.CrossRefPubMedPubMedCentral
12.
Pereira C, Bugalho A, Bergström S, Vaz F, Cotiro M. A comparative study of caesarean deliveries by assistant medical officers and obstetricians in Mozambique. BJOG. 1996;103:508–12.CrossRef
13.
Chilopora G, Pereira C, Kamwendo F, Chimbiri A, Malunga E, Bergstrom S. Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi. Hum Resour Health. 2007;5:17.CrossRefPubMedPubMedCentral
14.
Lehmann U. Mid-level health workers: the state of the evidence on programmes, activities, costs and impact on health outcomes. Geneva: World Health Organization; 2008.
15.
World Health Organization. World Health Report 2006: working together for health. Geneva: World Health Organization; 2006.CrossRef
16.
Ministry of Medical Services, Ministry of Public Health and Sanitation. National human resources for health annual report. Nairobi: Ministry of Medical Services, Ministry of Public Health and Sanitation; 2010.
17.
18.
Ministry of Health. The report on human resource mapping and verification exercise. Nairobi, Kenya: Ministry of Health; 2005.
19.
International Organization for Migration. Kenya mobility of health professionals. Brussels: International Organization for Migration; 2012.
20.
Ministry of Medical Services, Ministry of Public Health and Sanitation. Transforming health: accelerating attainment of health goals, Kenya Health Sector Strategic & Investment Plan (KHSSP) July 2012 – June 2017. Nairobi, Kenya: Ministry of Medical Services and Ministry of Public Health and Sanitation; 2012.
21.
22.
23.
Dillabaugh LL, Kulzer LJ, Owuor K, Ndege V, Oyanga A, Ngugi E, Shade SB, Bukusi E, Cohen CR: Towards elimination of mother-to-child transmission of HIV: the impact of a rapid results initiative in Nyanza Province, Kenya. AIDS Res Treat. 2012; 602120.
24.
Rose J, Bliemer M. Sample size requirements for stated choice experiments. Transportation. 2013;40:1021–41.CrossRef
25.
de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ. 2010;21:145–72.CrossRefPubMed
26.
Rockers PC, Jaskiewicz W, Wurts L, Kruk ME, Mgomella GS, Ntalazi F, et al. Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment. BMC Health Serv Res. 2012;12:212.CrossRefPubMedPubMedCentral
27.
Blaauw D, Erasmus E, Pagaiya N, Tangcharoensathein V, Mullei K, Mudhune S, et al. Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment. Bull World Health Organ. 2010;88:350–6.CrossRefPubMedPubMedCentral
28.
McFadden D. Conditional logit analysis of qualitative choice behavior. In: Zarembka P, editor. Frontiers in econometrics. New York: Academic; 1974. p. 105–42.
29.
Train K. Discrete choice methods with simulation. 2nd ed. Cambridge: Cambridge University Press; 2009.CrossRef
30.
Hole A, Kolstad J. Mixed logit estimation of willingness to pay distributions: a comparison of models in preference and WTP space using data from a health-related choice experiment. Empir Econ. 2011;42(2):445–69.CrossRef
31.
Hole A. Fitting mixed logit models by using maximum simulated likelihood. Stata Journal. 2007;7(3):388–401.
32.
Ministry of Medical Services, Ministry of Public Health and Sanitation. Training procedure guidelines. Nairobi: Ministry of Medical Services, Ministry of Public Health and Sanitation; 2011.
33.
Honda A, Vio F. Incentives for non-physician health professionals to work in the rural and remote areas of Mozambique—a discrete choice experiment for eliciting job preferences 2015. Hum Resour Health. 2015;13:23.CrossRefPubMedPubMedCentral
34.
35.
Manongi RN, Marchant TC, Bygbjerg IC. Improving motivation among primary health care workers in Tanzania: a health worker perspective. Hum Resour Health. 2006;4:6.CrossRefPubMedPubMedCentral
36.
Manafa O, McAuliffe E, Maseko F, Bowie C, MacLachlan M, Normand C. Retention of health workers in Malawi: perspectives of health workers and district management. Hum Resour Health. 2009;7:65.CrossRefPubMedPubMedCentral
37.
Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Motivation and retention of health workers in developing countries: a systematic review. BMC Health Serv Res. 2008;8:247.CrossRefPubMedPubMedCentral
38.
Kruk ME, Johnson JC, Gyakobo M, Agyei-Baffour P, Asabir K, Kotha SR, et al. Rural practice preferences among medical students in Ghana: a discrete choice experiment. Bull World Health Organ. 2010;88:333–41.CrossRefPubMedPubMedCentral
39.
40.
Mathauer I, Imhoff I. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Hum Resour Health. 2006;4:24.CrossRefPubMedPubMedCentral
41.
McCoy D, Bennett S, Witter S, Pond B, Baker B, Gow J, et al. Salaries and incomes of health workers in sub-Saharan Africa. Lancet. 2008;371:675–81.CrossRefPubMed
42.
Kolstad JR. How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania. Health Econ. 2011;20:196–211.CrossRefPubMed
43.
Rockers P, Jaskiewicz W, Kruk M, Phathammavong O, Vanghonevilay P, Paphassarang C, et al. Differences in preferences for rural job postings between nursing students and practicing nurses: evidence from a discrete choice experiment in Lao People’s Democratic Republic. Hum Resour Health. 2013;11:22.CrossRefPubMedPubMedCentral
44.
Araújo E, Maeda A. How to recruit and retain health workers in rural and remote areas in developing countries: a guidance note. Health, nutrition and population (HNP) discussion paper. Washington, D.C: World Bank; 2013.
45.
46.
Hole A. A comparison of approaches to estimating confidence intervals for willingness to pay measures. Health Econ. 2007;16:827–40.CrossRefPubMed
Metadata
Title
Job preferences among clinical officers in public sector facilities in rural Kenya: a discrete choice experiment
Authors
Toshio Takemura
Karina Kielmann
Duane Blaauw
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2016
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/s12960-015-0097-0

Other articles of this Issue 1/2016

Human Resources for Health 1/2016 Go to the issue

Research

A study of organizational versus individual needs related to recruitment, deployment and promotion of doctors working in the government health system in Odisha state, India

Research

Challenges for strengthening the health workforce in the Lao People’s Democratic Republic: perspectives from key stakeholders

Research

Is the Annual Confidential Report system effective? A study of the government appraisal system in Gujarat, India

Research

Transformational leadership, empowerment, and job satisfaction: the mediating role of employee empowerment

Case study

eSIP-Saúde: Mozambique’s novel approach for a sustainable human resources for health information system

Research

What do health workers in Timor-Leste want, know and do? Findings from a national health labour market survey