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What policies would attract health professionals to rural areas?

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What policies would attract health professionals to rural areas?

  1. 1. What policies would attract health professionals to rural areas? Evidence from South Africa, Thailand and Kenya<br />Duane Blaauw<br />Centre for Health Policy, South Africa<br />Delivering Effective Health Care for All<br />Monday 29th March, 2010<br />
  2. 2. Possible interventions to attract health workers to under-served areas?<br />Grobler et al <br />(2009) <br />
  3. 3. Evidence of policy effectiveness?<br />Cochrane review (2009) found no rigorous controlled studies <br />Need more rigorous evaluations of impact<br />Methodological challenges<br />RCTs may not be possible<br />RCTs may not be sufficient<br />Interim solutions?<br />Longitudinal HR databases<br />Modelling of stated preference data <br />
  4. 4. Study methods<br />Discrete choice experiment (DCE) with nursing graduates in South Africa, Thailand & Kenya<br />DCE Design<br />DCE Analysis<br />Used statistical model to investigate:<br />Rural uptake for different policy combinations<br />Cost-effectiveness of different interventions<br />
  5. 5. DCE design<br />Labelled design<br />Two choices<br />Annual Salary<br />6 different rural policy interventions<br />16 choice sets<br />
  6. 6. Different country preferences<br />
  7. 7. Impact of single interventions<br />
  8. 8. Impact of packages of interventions<br />
  9. 9. Cost-effectiveness of interventions (ZA)<br />
  10. 10. Incremental cost-effectiveness ratios<br />Early study leave + 20% rural allowance<br />ICER: R 590,988<br />Early study leave + car + 10% rural allowance<br />ICER: R 517,831<br />MORE COST-EFFECTIVE<br />Early study leave + car<br />ICER: R 313,096<br />Early study leave<br />ICER: R 250,065<br />Base cost<br />ICER: R 238,324<br />
  11. 11. Incremental cost-effectiveness ratios<br />ICER: R 590,988<br />ICER: R 558,983<br />ICER: R 318,519<br />ICER: R 252,608<br />Base cost: R 213,170<br />Base cost<br />ICER: R 238,324<br />
  12. 12. Implications for policy and practice<br />Policymakers in LMICs should make more use of modelling data to inform the design of HR policies. <br />There are no generic HR solutions. HR policies need to be tailored to individual country contexts. <br />A combination of financial and non-financial HR strategies is required. <br />Non-financial interventions can be as effective as salary increases and are more cost-effective. <br />Changing student selection is a very cost-effective strategy to increase health professionals in under-served areas. <br />
  13. 13. Partners<br />Kenya Medical Research Institute, Nairobi<br />KethiMullei, Sandra Mudhune, Jackie Wafula, Catherine Goodman, Mike English<br />Centre for Health Policy, Johannesburg<br />Duane Blaauw, Ermin Erasmus<br />International Health Policy Program, Bangkok<br />NonglakPagaiya, ThinakornNoree, VirojTangcharoensathien<br />London School of Hygiene and Tropical Medicine<br />MyleneLagarde<br />

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