title: Addressing health workforce distribution concerns: a discrete choice experiment to develop rural retention strategies in Cameroon.
abstract: BACKGROUND
  Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH) is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas.
  
  
  METHODS
  To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE) was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data.
  
  
  RESULTS
  Among medical and nursing students a rural retention bonus of 75% of base salary (aOR= 8.27, 95% CI: 5.28-12.96, P< 0.001) and improved health facility infrastructure (aOR= 3.54, 95% CI: 2.73-4.58) respectively were the attributes with the largest effect sizes. Among medical doctors and nurse aides, a rural retention bonus of 75% of base salary was the attribute with the largest effect size (medical doctors aOR= 5.60, 95% CI: 4.12-7.61, P< 0.001; nurse aides aOR= 4.29, 95% CI: 3.11-5.93, P< 0.001). On the other hand, improved health facility infrastructure (aOR= 3.56, 95% CI: 2.75-4.60, P< 0.001), was the attribute with the largest effect size among the state registered nurses surveyed. Willingness-to-Pay (WTP) estimates were generated for each health worker cadre for all the attributes. Preference impact measurements were also estimated to identify combination of incentives that health workers would find most attractive.
  
  
  CONCLUSIONS
  Based on these findings, the study recommends the introduction of a system of substantial monetary bonuses for rural service along with ensuring adequate and functional equipment and uninterrupted supplies. By focusing on the analysis of locally relevant, actionable incentives, generated through the involvement of policy-makers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health.
authors.affiliation: The World Bank, Cameroon Country Office, Yaoundé, Cameroon.
authors.forename: Paul Jacob
authors.initials: PJ
authors.lastname: Robyn
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Shroff
authors.affiliation: The World Bank, Cameroon Country Office, Yaoundé, Cameroon.
authors.forename: Omer Ramses
authors.initials: OR
authors.lastname: Zang
authors.affiliation: Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kingue
authors.affiliation: Institute for Survey and Statistical Analysis, Yaoundé, Cameroon.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Djienouassi
authors.affiliation: Institute for Survey and Statistical Analysis, Yaoundé, Cameroon.
authors.forename: Christian
authors.initials: C
authors.lastname: Kouontchou
authors.affiliation: The World Bank, Cameroon Country Office, Yaoundé, Cameroon.
authors.forename: Gaston
authors.initials: G
authors.lastname: Sorgho
keywords: Cameroon, Human Resources For Health; Discrete Choice Experiment (DCE); Rural Retention Strategies