Rural practice preferences among medical students in Ghana: a discrete choice experiment

Objective To determine how specific job attributes influenced fourth year medical students' stated preference for hypothetical rural job postings in Ghana.Methods Based on discussions with medical student focus groups and physicians in practice and in the Ministry of Health; we created a discrete choice experiment(DCE) that assessed how students' stated preference for certain rural postings was influenced by various job attributes: a higher salary; free superior housing; an educational allowance for children; improved equipment; supportive management; shorter contracts before study leave and a car. We conducted the DCE among all fourth year medical students in Ghana using a brief structured questionnaire and used mixed logit models to estimate the utility of each job attribute. Findings Complete data for DCE analysis were available for 302 of 310 (97) students. All attribute parameter estimates differed significantly from zero and had the expected signs. In the main effects mixed logit model; improved equipment and supportive management were most strongly associated with job preference (a = 1.42; 95 confidence interval; CI: 1.17 to 1.66; and a = 1.17; 95CI: 0.96 to 1.39; respectively); although shorter contracts and salary bonuses were also associated. Discontinuing the provision of basic housing had a large negative influence (a = .1.59; 95CI: .1.88 to .1.31). In models including gender interaction terms; women's preferences were more influenced by supportive management and men's preferences by superior housing. Conclusion Better working conditions were strongly associated with the stated choice of hypothetical rural postings among fourth year Ghanaian medical students. Studies are needed to find out whether job attributes determine the actual uptake of rural jobs by graduating physicians

Availability of essential health services in post-conflict Liberia

Objective:To assess the availability of essential health services in northern Liberia in 2008; five years after the end of the civil war. Methods We carried out a population-based household survey in rural Nimba county and a health facility survey in clinics and hospitals nearest to study villages. We evaluated access to facilities that provide index essential services: artemisinin combination therapy for malaria; integrated management of childhood illness; human immunodeficiency virus (HIV) counselling and testing; basic emergency obstetric care and treatment of mental illness. Findings Data were obtained from 1405 individuals (98response rate) selected with a three-stage population- representative sampling method; and from 43 of Nimba county's 49 health facilities selected because of proximity to the study villages. Respondents travelled an average of 136 minutes to reach a health facility. All respondents could access malaria treatment at the nearest facility and 55.9could access HIV testing. Only 26.8; 14.5; and 12.1could access emergency obstetric care; integrated management of child illness and mental health services; respectively. Conclusion Although there has been progress in providing basic services; rural Liberians still have limited access to life-saving health care. The reasons for the disparities in the services available to the population are technical and political. More frequently available services (HIV testing; malaria treatment) were less complex to implement and represented diseases favoured by bilateral and multilateral health sector donors. Systematic investments in the health system are required to ensure that health services respond to current and future health priorities