IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v169y2016icp109-118.html
   My bibliography  Save this article

The use of specialty training to retain doctors in Malawi: A discrete choice experiment

Author

Listed:
  • Mandeville, Kate L.
  • Ulaya, Godwin
  • Lagarde, Mylène
  • Muula, Adamson S.
  • Dzowela, Titha
  • Hanson, Kara

Abstract

Emigration has contributed to a shortage of doctors in many sub-Saharan African countries. Specialty training is highly valued by doctors and a potential tool for retention. Yet not all types of training may be valued equally. In the first study to examine preferences for postgraduate training in depth, we carried out a discrete choice experiment as part of a cross-sectional survey of all Malawian doctors within seven years of graduation and not yet in specialty training. Over August 2012 to March 2013, 148 doctors took part out of 153 eligible in Malawi. Despite evidence that specialty training is highly sought after, Malawian junior doctors would not accept all types of training. Doctors preferred timely training outside of Malawi in core specialties (internal medicine, general surgery, paediatrics, obstetrics & gynaecology). Specialty preferences are particularly strong, with most junior doctors requiring nearly double their monthly salary to accept training all in Malawi and over six-fold to accept training in ophthalmology (representing a bundle of unpopular but priority specialties). In contrast, the location of work before training did not significantly influence most doctors' choices when guaranteed specialty training. Using a latent class model, we identified four subgroups of junior doctors with distinct preferences. Policy simulations showed that these preferences could be leveraged by policymakers to improve retention in exchange for guaranteed specialty training, however incentivising the uptake of training in priority specialties will only be effective in those with more flexible preferences. These results indicate that indiscriminate expansion of postgraduate training to slow emigration of doctors from sub-Saharan African countries may not be effective unless doctors' preferences are taken into account.

Suggested Citation

  • Mandeville, Kate L. & Ulaya, Godwin & Lagarde, Mylène & Muula, Adamson S. & Dzowela, Titha & Hanson, Kara, 2016. "The use of specialty training to retain doctors in Malawi: A discrete choice experiment," Social Science & Medicine, Elsevier, vol. 169(C), pages 109-118.
  • Handle: RePEc:eee:socmed:v:169:y:2016:i:c:p:109-118
    DOI: 10.1016/j.socscimed.2016.09.034
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S027795361630541X
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2016.09.034?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Mylene Lagarde & Nonglak Pagaiya & Viroj Tangcharoensathian & Duane Blaauw, 2013. "One Size Does Not Fit All: Investigating Doctors' Stated Preference Heterogeneity For Job Incentives To Inform Policy In Thailand," Health Economics, John Wiley & Sons, Ltd., vol. 22(12), pages 1452-1469, December.
    2. Louviere, Jordan J. & Lancsar, Emily, 2009. "Choice experiments in health: the good, the bad, the ugly and toward a brighter future," Health Economics, Policy and Law, Cambridge University Press, vol. 4(4), pages 527-546, October.
    3. Michael Clark & Domino Determann & Stavros Petrou & Domenico Moro & Esther Bekker-Grob, 2014. "Discrete Choice Experiments in Health Economics: A Review of the Literature," PharmacoEconomics, Springer, vol. 32(9), pages 883-902, September.
    4. Krishna D Rao & Mandy Ryan & Zubin Shroff & Marko Vujicic & Sudha Ramani & Peter Berman, 2013. "Rural Clinician Scarcity and Job Preferences of Doctors and Nurses in India: A Discrete Choice Experiment," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-9, December.
    5. Greene, William H. & Hensher, David A., 2003. "A latent class model for discrete choice analysis: contrasts with mixed logit," Transportation Research Part B: Methodological, Elsevier, vol. 37(8), pages 681-698, September.
    6. Mandy Ryan & Diane Skåtun, 2004. "Modelling non‐demanders in choice experiments," Health Economics, John Wiley & Sons, Ltd., vol. 13(4), pages 397-402, April.
    7. Mickael Bech & Dorte Gyrd‐Hansen, 2005. "Effects coding in discrete choice experiments," Health Economics, John Wiley & Sons, Ltd., vol. 14(10), pages 1079-1083, October.
    8. Sivey, Peter & Scott, Anthony & Witt, Julia & Joyce, Catherine & Humphreys, John, 2012. "Junior doctors’ preferences for specialty choice," Journal of Health Economics, Elsevier, vol. 31(6), pages 813-823.
    9. Scott, Anthony & Witt, Julia & Humphreys, John & Joyce, Catherine & Kalb, Guyonne & Jeon, Sung-Hee & McGrail, Matthew, 2013. "Getting doctors into the bush: General Practitioners' preferences for rural location," Social Science & Medicine, Elsevier, vol. 96(C), pages 33-44.
    10. Emily Lancsar & Jordan Louviere, 2006. "Deleting ‘irrational’ responses from discrete choice experiments: a case of investigating or imposing preferences?," Health Economics, John Wiley & Sons, Ltd., vol. 15(8), pages 797-811, August.
    11. Arne Risa Hole, 2007. "A comparison of approaches to estimating confidence intervals for willingness to pay measures," Health Economics, John Wiley & Sons, Ltd., vol. 16(8), pages 827-840, August.
    12. repec:bla:scotjp:v:47:y:2000:i:5:p:504-24 is not listed on IDEAS
    13. Madeleine T. King & Jane Hall & Emily Lancsar & Denzil Fiebig & Ishrat Hossain & Jordan Louviere & Helen K. Reddel & Christine R. Jenkins, 2007. "Patient preferences for managing asthma: results from a discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 16(7), pages 703-717, July.
    14. Mandy Ryan & Karen Gerard & Gillian Currie, 2012. "Using Discrete Choice Experiments in Health Economics," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 41, Edward Elgar Publishing.
    15. Vujicic, Marko & Shengelia, Bakhuti & Alfano, Marco & Thu, Ha Bui, 2011. "Physician shortages in rural Vietnam: Using a labor market approach to inform policy," Social Science & Medicine, Elsevier, vol. 73(7), pages 970-977.
    16. Esther W. de Bekker‐Grob & Mandy Ryan & Karen Gerard, 2012. "Discrete choice experiments in health economics: a review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 145-172, February.
    17. Ulla Slothuus Skjoldborg & Dorte Gyrd‐Hansen, 2003. "Conjoint analysis. The cost variable: an Achilles' heel?," Health Economics, John Wiley & Sons, Ltd., vol. 12(6), pages 479-491, June.
    18. Mandy Ryan & Sarah Wordsworth, 2000. "Sensitivity of Willingness to Pay Estimates to the Level of Attributes in Discrete Choice Experiments," Scottish Journal of Political Economy, Scottish Economic Society, vol. 47(5), pages 504-524, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Arora, Nikita & Quaife, Matthew & Hanson, Kara & Lagarde, Mylène & Woldesenbet, Dorka & Seifu, Abiy & Crastes dit Sourd, Romain, 2022. "Discrete choice analysis of health worker job preferences in Ethiopia: separating attribute non-attendance from taste heterogeneity," LSE Research Online Documents on Economics 113529, London School of Economics and Political Science, LSE Library.
    2. Bertoni, Marco & Chattopadhyay, Debdeep & Gu, Yuanyuan, 2023. "Medical Brain Drain – Assessing the Role of Job Attributes and Individual Traits," IZA Discussion Papers 16243, Institute of Labor Economics (IZA).
    3. Mandeville, Kate L. & Hanson, Kara & Muula, Adamson S. & Dzowela, Titha & Ulaya, Godwin & Lagarde, Mylène, 2017. "Specialty training for the retention of Malawian doctors: A cost-effectiveness analysis," Social Science & Medicine, Elsevier, vol. 194(C), pages 87-95.
    4. Saran, Indrani & Winn, Laura & Kipkoech Kirui, Joseph & Menya, Diana & Prudhomme O'Meara, Wendy, 2020. "The relative importance of material and non-material incentives for community health workers: Evidence from a discrete choice experiment in Western Kenya," Social Science & Medicine, Elsevier, vol. 246(C).
    5. Arora, Nikita & dit Sourd, Romain Crastes & Quaife, Matthew & Vassall, Anna & Ferrari, Giulia & Alangea, Deda Ogum & Tawiah, Theresa & Dwommoh Prah, Rebecca Kyerewaa & Jewkes, Rachel & Hanson, Kara & , 2023. "The stated preferences of community-based volunteers for roles in the prevention of violence against women and girls in Ghana: A discrete choice analysis," Social Science & Medicine, Elsevier, vol. 324(C).
    6. Matthew Quaife & Robyn Eakle & Maria A. Cabrera Escobar & Peter Vickerman & Maggie Kilbourne-Brook & Mercy Mvundura & Sinead Delany-Moretlwe & Fern Terris-Prestholt, 2018. "Divergent Preferences for HIV Prevention: A Discrete Choice Experiment for Multipurpose HIV Prevention Products in South Africa," Medical Decision Making, , vol. 38(1), pages 120-133, January.
    7. Nikita Arora & Matthew Quaife & Kara Hanson & Mylene Lagarde & Dorka Woldesenbet & Abiy Seifu & Romain Crastes dit Sourd, 2022. "Discrete choice analysis of health worker job preferences in Ethiopia: Separating attribute non‐attendance from taste heterogeneity," Health Economics, John Wiley & Sons, Ltd., vol. 31(5), pages 806-819, May.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mehdi Ammi & Christine Peyron, 2016. "Heterogeneity in general practitioners’ preferences for quality improvement programs: a choice experiment and policy simulation in France," Health Economics Review, Springer, vol. 6(1), pages 1-11, December.
    2. Jon Helgheim Holte & Peter Sivey & Birgit Abelsen & Jan Abel Olsen, 2016. "Modelling Nonlinearities and Reference Dependence in General Practitioners' Income Preferences," Health Economics, John Wiley & Sons, Ltd., vol. 25(8), pages 1020-1038, August.
    3. Emily Lancsar & Peter Burge, 2014. "Choice modelling research in health economics," Chapters, in: Stephane Hess & Andrew Daly (ed.), Handbook of Choice Modelling, chapter 28, pages 675-687, Edward Elgar Publishing.
    4. Haghani, Milad & Bliemer, Michiel C.J. & Hensher, David A., 2021. "The landscape of econometric discrete choice modelling research," Journal of choice modelling, Elsevier, vol. 40(C).
    5. Joachim Marti & John Buckell & Johanna Catherine Maclean & Jody L. Sindelar, 2016. "To ‘Vape’ or Smoke? A Discrete Choice Experiment Among U.S. Adult Smokers," NBER Working Papers 22079, National Bureau of Economic Research, Inc.
    6. Peyron, Christine & Pélissier, Aurore & Béjean, Sophie, 2018. "Preference heterogeneity with respect to whole genome sequencing. A discrete choice experiment among parents of children with rare genetic diseases," Social Science & Medicine, Elsevier, vol. 214(C), pages 125-132.
    7. Chiara Seghieri & Alessandro Mengoni & Sabina Nuti, 2014. "Applying discrete choice modelling in a priority setting: an investigation of public preferences for primary care models," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(7), pages 773-785, September.
    8. Buckell, John & Hess, Stephane, 2019. "Stubbing out hypothetical bias: improving tobacco market predictions by combining stated and revealed preference data," Journal of Health Economics, Elsevier, vol. 65(C), pages 93-102.
    9. Genie, Mesfin G. & Ryan, Mandy & Krucien, Nicolas, 2021. "To pay or not to pay? Cost information processing in the valuation of publicly funded healthcare," Social Science & Medicine, Elsevier, vol. 276(C).
    10. Chen, Gang & Ratcliffe, Julie & Milte, Rachel & Khadka, Jyoti & Kaambwa, Billingsley, 2021. "Quality of care experience in aged care: An Australia-Wide discrete choice experiment to elicit preference weights," Social Science & Medicine, Elsevier, vol. 289(C).
    11. Mamine, Fateh & Fares, M'hand & Minviel, Jean Joseph, 2020. "Contract Design for Adoption of Agrienvironmental Practices: A Meta-analysis of Discrete Choice Experiments," Ecological Economics, Elsevier, vol. 176(C).
    12. Holte, Jon Helgheim & Kjaer, Trine & Abelsen, Birgit & Olsen, Jan Abel, 2015. "The impact of pecuniary and non-pecuniary incentives for attracting young doctors to rural general practice," Social Science & Medicine, Elsevier, vol. 128(C), pages 1-9.
    13. Sicsic, Jonathan & Krucien, Nicolas & Franc, Carine, 2016. "What are GPs' preferences for financial and non-financial incentives in cancer screening? Evidence for breast, cervical, and colorectal cancers," Social Science & Medicine, Elsevier, vol. 167(C), pages 116-127.
    14. Pedro Ramos & Hélio Alves & Paulo Guimarães & Maria A. Ferreira, 2017. "Junior doctors’ medical specialty and practice location choice: simulating policies to overcome regional inequalities," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(8), pages 1013-1030, November.
    15. Pestana, Joana & Frutuoso, João & Costa, Eduardo & Fonseca, Filipa, 2024. "Heterogeneity in physician's job preferences in a dual practice context – Evidence from a DCE," Social Science & Medicine, Elsevier, vol. 343(C).
    16. Alessandro Mengoni & Chiara Seghieri & Sabina Nuti, 2013. "The application of discrete choice experiments in health economics: a systematic review of the literature," Working Papers 201301, Scuola Superiore Sant'Anna of Pisa, Istituto di Management.
    17. Andersson, Henrik & Hole, Arne Risa & Svensson, Mikael, 2016. "Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety," Journal of Environmental Economics and Management, Elsevier, vol. 75(C), pages 41-53.
    18. Waleska Sigüernza & Petr Mariel, 2013. "Valoración económica de los servicios sanitarios en la Comunidad Autónoma del País Vasco," Hacienda Pública Española / Review of Public Economics, IEF, vol. 207(4), pages 71-99, December.
    19. Mina Bahrampour & Joshua Byrnes & Richard Norman & Paul A. Scuffham & Martin Downes, 2020. "Discrete choice experiments to generate utility values for multi-attribute utility instruments: a systematic review of methods," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(7), pages 983-992, September.
    20. Mickael Bech & Trine Kjaer & Jørgen Lauridsen, 2011. "Does the number of choice sets matter? Results from a web survey applying a discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 20(3), pages 273-286, March.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:169:y:2016:i:c:p:109-118. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.