Study of Attrition, Availability, and Retention of Midwife Service Scheme Officers in Nigeria

The Midwives Service Scheme, established in 2009 to reduce Nigeria’s high maternal mortality rate, supplies midwives to rural and remote areas where they are most needed. CapacityPlus collaborated with the National Primary Health Care Development Agency to study factors underpinning attrition, availability, and retention of personnel and propose measures for motivating and retaining rural-based midwives. Presented at the Third Global Symposium on Health Systems Research in Cape Town, South Africa, on October 1, 2014, this poster presents findings from the study.

WHO Recommendations for Transforming and Scaling Up Health Workforce Education, and for Retaining Health Workers in Rural and Remote Areas

This presentation was given at the CapacityPlus knowledge-sharing and dissemination event, Transforming and Scaling Up Health Workforce Education and Training for Health Equity, held on March 18, 2014, at the National Press Club in Washington, DC.

Early Implementation of WHO Recommendations for the Retention of Health Workers in Remote and Rural Areas

The World Health Organization (WHO) issued 16 global recommendations for improving the recruitment and retention of health workers in rural areas—a challenge faced by most countries and a barrier to universal health coverage. This article discusses the challenges and lessons learned from adaptation and adoption of the recommendations in Lao People’s Democratic Republic and South Africa, and explores the influence of the recommendations regionally in Asia and Europe. In Lao PDR, the Ministry of Health partnered with CapacityPlus and the WHO to apply the Rapid Retention Survey Toolkit (developed by CapacityPlus using the WHO recommendations) and iHRIS Retain costing software to assess which of the recommendations would be most effective in the Laotian context and subsequently inform a new national policy for recruiting and retaining health workers.

Net Costs of Health Worker Rural Incentive Packages: An Example from the Lao People’s Democratic Republic

Many developing countries are examining whether to institute incentive packages that increase the share of health workers who opt to locate in rural settings; however, uncertainty exists with respect to the expected net cost (or benefit) from these packages. CapacityPlus utilized findings from discrete choice experiment surveys applied to students training to be health professionals and costing analyses in Lao People’s Democratic Republic to model the anticipated effect of incentive packages on new worker location decisions and direct costs. In this example, incentive packages that do not invest in capital-intensive components generally should produce larger net benefits. Combining discrete choice experiment surveys, costing surveys, and cost-benefit analysis methods may be replicated by other developing countries to calculate whether health worker incentive packages are viable policy options.

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

A discrete choice experiment was conducted to investigate preferences for job characteristics among nursing students and practicing nurses to understand whether differing policies may be appropriate for each group. Data were collected from 256 nursing students and 249 practicing nurses. For both groups, choice of job posting was strongly influenced by salary and direct promotion to permanent staff. As compared to nursing students, practicing nurses had significantly lower preference for housing allowance and housing provision as well as lower preference for provision of transportation for work and personal use. Findings suggest that it may be important to differentiate between recruitment and retention policies when addressing human resources for health challenges in developing countries, such as Lao PDR.

Rapid Retention Survey Toolkit: Designing Evidence-Based Incentives for Health Workers

Rapid Retention Survey ToolkitThe Rapid Retention Survey Toolkit is designed to help countries determine what would motivate health workers to accept and remain in rural posts. It builds on the World Health Organization global policy recommendations for rural retention and is based on the discrete choice experiment (DCE), a powerful research method that identifies the trade-offs professionals are willing to make between specific job characteristics and determines their preferences for various incentive packages, including the probability of accepting a post in a rural facility. Employing a simplified version of the DCE methodology, the toolkit guides HR managers through the survey process to quickly assess health students’ and health workers’ motivational preferences to accept a position and continue working in underserved facilities. The results can be used to create evidence-based incentive packages that are appropriate within a country’s health labor market. Read more »

Toward Development of a Rural Retention Strategy in Lao People’s Democratic Republic: Understanding Health Worker Preferences

This technical report presents the results of a discrete choice experiment (DCE) conducted by the Lao People’s Democratic Republic Ministry of Health, in partnership with the World Health Organization and CapacityPlus, using CapacityPlus’s rural retention survey toolkit. The DCE surveyed health professional students and health workers practicing in rural provinces to investigate their motivational preferences for potential strategies to increase attraction and retention in the country’s rural and remote settings.

Determining Priority Retention Packages to Attract and Retain Health Workers in Rural and Remote Areas in Uganda

In Uganda, attracting and retaining health workers in rural and underserved areas has proven difficult. Positions staffed by the Ministry of Health in many of these areas remain 50% vacant. The Ministry of Health is committed to pursuing a package of strategies to make rural postings more attractive. One important step in determining which package of strategies will be most effective is to estimate which strategies health workers themselves most prefer. To this end, the Ministry of Health, in partnership with CapacityPlus, conducted a discrete choice experiment survey among current students in health training programs as well as health workers practicing in rural districts to investigate preferences for potential attraction and retention strategies. The results constitute an important input to the policy-making process related to the identification, costing, and selection of possible retention interventions for implementation. Read more »

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