Encouraging junior doctors to work in rural Sudan: a discrete choice experiment.

ABSTRACT

BACKGROUND: Out-migration of physicians and urban-rural maldistribution are two of the most serious challenges facing the health sector. AIMS: To determine the preference of junior doctors for rural postings in Sudan, and estimate how much junior doctors are willing to trade off from their salaries for nonmonetary incentives. METHODS: The study targeted junior doctors who had completed their internship training and were taking their Medical Licensing Examination at the Sudan Medical Council for permanent registration. Focus group discussions were conducted to identify potentially valued incentives. A computer-based discrete choice experiment and accompanying questionnaire were administered between September and October 2012 at the two licence examination centres in Sudan. RESULTS: Four hundred and fifty-five doctors completed the survey. More than one third of the respondents intended to emigrate from Sudan immediately and another 30% within the next two years. The findings showed that providing scholarships to train abroad, improving the standard of health facilities to an advanced level, and providing on-site supervision were the attributes most preferred by the respondents and they were willing to trade off SDG 3650 (US$ 608), SDG 1997 (US$ 333) and SDG 1948 (US$ 325) of their salaries for these, respectively. Less-preferred attributes were availability of supervision by telephone, followed by a scholarship in family medicine and a 2-year commitment, post-training. CONCLUSIONS: Authorities may consider the above preferences to enhance human resources for attraction strategies in rural areas. Addressing the supervision issue may be more feasible for policy-makers in the short term, when compared to improving salaries and infrastructure.