Incentives

Pay for performance schemes are increasingly being implemented in low income countries to improve health service coverage and quality. This paper describes the context within which a pay for performance programme was introduced in Tanzania and discusses the potential for pay for performance to address health system constraints to meeting targets. [from abstract]

Performance-based incentives (PBIs) are currently receiving attention as a strategy for improving the quality of care that health providers deliver. Experiences from several African countries have shown that PBIs can trigger improvements, particularly in the area of maternal and neonatal health. The involvement of health workers in deciding how their performance should be measured is recommended. Only limited information is available about how such schemes can be made sustainable. [from introduction]

Despite the growing interest in the private health sector in low- and middle-income countries, little is known about physicians working outside the public sector. The paper’s objective is to contribute to the understanding of such physicians, ultimately informing the policies regulating the medical profession in low- and middle-income countries. [adapted from abstract]

The objective of the study was to identify a package for attracting and retaining health workers in underserved areas. [from abstract]

The aim of this study is to examine the preferences of general practitioners (GPs) for rural location using a discrete choice experiment to estimate the probabilities of moving to a rural area, and the size of financial incentives GPs would require to move there. [adapted from abstract]

This study investigates the causes of migration focusing on the role of salaries and benefits. Health professionals from public, private and non-governmental health facilities located in selected peri-urban and urban areas in KwaZulu-Natal, South Africa were surveyed about their current positions and attitudes toward migration. [from abstract]

This paper aims to outline the magnitude of unequal health workforce distribution in the developing countries; summarize the evidence on the factors that contribute to these imbalances; present a systematic set of policy interventions that are being implemented to address the problem of recruitment and retention of health workers in rural and remote regions of developing countries; and introduce the Discrete Choice Experiment to elicit health workers’ preferences and factors likely to increase uptake of a rural or remote job. [adapted from abstract]

Given the complexity of the social, professional and economic factors that influence motivation, this article addresses how institutions make rural job postings more attractive and how they can identify what kinds of incentive packages can attract and motivate young, bright graduates to serve the areas of their country that are most in need. [adapted from author]

A discrete choice experiment was conducted to investigate preferences for job characteristics among nursing students and practicing nurses to determine how these groups vary in their respective preferences and to understand whether differing policies may be appropriate for each group. [from abstract]

This quantitative research study used a computerized structured survey containing a discrete choice experiment (DCE) to quantify the importance of different incentives and policies to encourage service to deprived, rural and remote areas by upper-year midwifery students following graduation. [from abstract]

This study explores the role of provider motivation in the quality of maternal and neonatal care. The main research questions were: which factors motivated these respondents to join the health professions; what is understood by the term motivation; what influences their motivation, job satisfaction and the quality of their care; and which incentives do these providers themselves suggest. [adapted from author]

This guide aims to provide easy-to-read information and step-by-step advice on a quantitative research method that can help identify appropriate policy responses to health workforce shortages in remote and rural areas. It uses two case studies to illustrate the challenges and the ways to overcome them in conducting the work. [from author]

Recent policy recommendations have called for increased research efforts to inform the design of cost-effective interventions to address the shortage of health workers in rural areas. This paper takes forward the recent use of discrete choice experiments to assess the effects of potential incentives to attract nurses to rural areas. [from abstract]

A discrete choice experiment was conducted to evaluate the job preferences of nurses and midwives currently working on a short-term contract in the public sector in Ayacucho, Peru to assess factors that would attract short-term contract nurses and midwives to work in a rural area of Peru. [adapted from abstract]

This toolkit is intended to allow human resources managers to determine health professionals’ motivational preferences for accepting and remaining in posts. The toolkit builds on the WHO global policy recommendations for rural retention and is based on the discrete choice experiment, a powerful research method that identifies the trade-offs health professionals (or other types of workers) 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 health facility.

This free online course, developed by the HRH Global Resource Center and CapacityPlus, is based on the Rapid Retention Survey Toolkit. This course will orient participants on how to use a rapid discrete choice experiment methodology to design evidence-based incentives to attract and retain health workers in rural and remote areas. [from publisher]

This report examines working conditions of health workers in Nepal in relation to income and incentives, work supplies and equipment, issues on safety and security and the role of local authorities and the community. [from summary]

A discrete choice experiment was used to test how nurses and certified midwives in Liberia would respond to alternative policies being considered by the ministry of health and social welfare to predict the share of nurses and certified midwives who would accept a job in a rural area under different schemes. [from abstract]

This study investigated preferences for job characteristics among final year medical, nursing, pharmacy, and laboratory students at select universities in Uganda to elicit preferences for attributes of potential job postings they were likely to pursue after graduation. [adapted from abstract]

Although a community-based health insurance scheme (CBI) was introduced in Burkina Faso, coverage has remained low and dropout rates high because health workers are dissatisfied with the provider payment mechanism. This research was used to examine CBI provider payment attributes that influence healthcare workers’ stated preferences for payment mechanisms. [adapted from abstract]

The paper describes performance-based incentive contracting schemes that have been implemented to improve results for a range of interventions from time-limited immunizations to chronic conditions that require significant lifestyle changes, such as diabetes. It argues that performance incentives are a viable and potentially more powerful solution than typical inputoriented approaches to dealing with underutilization, poor quality, and low efficiency. [from publisher]

This paper provides a detailed analysis of the complete responses from an online survey to capture developing country experience with pay for performance - a strategy that is increasingly being introduced with the goal of improving maternal and child health outcomes. [adapted from author]

This study reviews experiences and lessons learned regarding monetary and non-monetary incentives for community workers. It includes indicative costings and recommendations for further policy and development with regard to the effective recruitment, training and deployment of community workers in Zambia. [adapted from summary]

Using qualitative data from Rwanda, this study focuses on four institutional factors that affect health worker performance and career choice: incentives, monitoring arrangements, professional norms and health workers’ intrinsic motivation. It also provides illustrations of three institutional innovations that work, at least in the context of Rwanda: performance pay, the establishment of community health workers and increased attention to the training of health workers. [adapted from introduction]

This paper estimates the effectiveness of a range of policy interventions aimed at improving the supply of health workers to rural areas in Ethiopia. Using data from a survey of 861 health workers, it employs stated preference techniques to predict labor market responses of doctors and nurses to changes in rural wages, working conditions, housing bene…ts, and training opportunities. [from abstract]

This study carries out a microeconomic labor analysis of health worker career choice and of job behavior. It shows how common problems related to distribution or performance of HRH are driven by the behavior of health workers themselves and are determined largely by select monetary and nonmonetary compensation. [from abstract]

This document analalyzes the effectiveness of performance incentive schemes in developing countries that comprise maternal health components, including family planning. [adapted from author]

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. [from publisher]

The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana including salary, infrastructure, management style, and contract length in considering future jobs. [from author]

This paper presents a summary of a regional program on incentives for health worker retention. The studies sought to investigate the causes of migration of health professionals, the strategies used to retain health professionals, how they are being implemented, monitored and evaluated, as well as their impact, to make recommendations to enhance the monitoring, evaluation and management of non-financial incentives for health worker retention. [from summary]