Retention

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.

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.

Discrete Choice Experiment User Guide

Understanding why health workers want or don’t want to take posts and remain in remote and rural areas is a prerequisite to formulating appropriate policy responses to the shortage of health workers in these areas. Building on the World Health Organization (WHO) Guidelines on Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention, this user guide proposes an innovative methodology, the discrete choice experiment (DCE), to measure the strength of health workers’ preferences and trade-offs related to different job characteristics that can influence their decision to take up rural postings. The user guide offers step-by-step advice on the application of DCE to identify policy interventions appropriate to a particular country context. The guide is the product of close collaboration among three agencies—the World Bank, the WHO, and USAID/CapacityPlus—and represents their shared commitment to supporting policy-relevant research on critical topics related to human resources for health.