Browsing by Person "Shengalia, Bakhuti"

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Attracting doctors and medical students to rural Vietnam: insights from a Discrete Choice Experiment
(HNP Discussion Paper. Washington, DC: World Bank., 2010-12) Vujicic, Marko; Alfano, Marco; Shengalia, Bakhuti; Witter, Sophie
Persuading medical doctors to work in rural areas is one of the main challenges facing health policy makers, in both developing and developed countries. Discrete choice experiments (DCEs) have increasingly been used to analyze the preferences of health workers, and how they would respond to alternative incentives associated with working in a rural location. Previous DCE studies focusing on the rural recruitment and retention problem have sampled either in-service health workers or students in the final year of their training program. This study is the first to sample both of these groups in the same setting. We carry out a DCE to compare how doctors and final-year medical students in Vietnam value six job attributes, and use the results to simulate the impact of alternative incentive packages on recruitment in rural areas. Results show significant differences between the two groups. The location of workplace (rural or urban) was by far the most important attribute for doctors; for medical students it was long-term education. More surprising, however, was the magnitude of the differences: there were fivefold differences in willingness-to-pay estimates for some job attributes. These differences strongly suggest that policy makers in Vietnam should consider moving away from the current uniform approach to rectifying rural shortages and tailor separate incentive packages to students and doctors. Our results also suggest that future DCE studies should carefully consider the choice of sample if results are to be used for policy making.
Understanding the 'four directions of travel': qualitative research into the factors affecting recruitment and retention of doctors in rural Vietnam.
(BioMed Central, 2011-08-17) Witter, Sophie; Ha, B. T.; Shengalia, Bakhuti; Vujicic, Marko
Background Motivation and retention of health workers, particularly in rural areas, is a question of considerable interest to policy-makers internationally. Many countries, including Vietnam, are debating the right mix of interventions to motivate doctors in particular to work in remote areas. The objective of this study was to understand the dynamics of the health labour market in Vietnam, and what might encourage doctors to accept posts and remain in-post in rural areas. Methods This study forms part of a labour market survey which was conducted in Vietnam in November 2009 to February 2010. The study had three stages. This article describes the findings of the first stage - the qualitative research and literature review, which fed into the design of a structured survey (second stage) and contingent valuation (third stage). For the qualitative research, three tools were used - key informant interviews at national and provincial level (6 respondents); in-depth interviews of doctors at district and commune levels (11 respondents); and focus group discussions with medical students (15 participants). Results The study reports on the perception of the problem by national level stakeholders; the motivation for joining the profession by doctors; their views on the different factors affecting their willingness to work in rural areas (including different income streams, working conditions, workload, equipment, support and supervision, relationships with colleagues, career development, training, and living conditions). It presents findings on their overall satisfaction, their ranking of different attributes, and willingness to accept different kinds of work. Finally, it discusses recent and possible policy interventions to address the distribution problem. Conclusions Four typical 'directions of travel' are identified for Vietnamese doctors - from lower to higher levels of the system, from rural to urban areas, from preventive to curative health and from public to private practice. Substantial differences in income from formal and informal sources all reinforce these preferences. While non-financial attributes are also important for Vietnamese doctors, the scale of the difference of opportunities presents a considerable policy challenge. Significant salary increases for doctors in hard-to-staff areas are likely to have some impact. However, addressing the differentials is likely to require broader market reforms and regulatory measures.