Factors that influence midwifery students in Ghana when deciding where to practice: a discrete choice experiment
Factors that influence midwifery students in Ghana when deciding where to practice: a discrete choice experiment
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DOI：
10.1186/1472-6920-13-64
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发表时间：
2013-05-04
影响因子：
3.6
通讯作者：
Lori, Jody R.
中科院分区：
文献类型：
--
作者：
Ageyi-Baffour, Peter;Rominski, Sarah;Lori, Jody R.
背景：卫生人力分布不均，城市生活严重偏向，是加纳扩大助产服务的主要制约因素。根据联合国千年发展目标（MDG）的报告，非洲在怀孕或分娩期间死亡的高风险仍然存在。产妇死亡率目前估计为每10万人350人，部分原因是分娩期间专业支助率低。加纳农村地区的许多妇女单独或与非技术助产士一起分娩。助产士是实现千年发展目标的关键保健提供者，特别是在到2015年将孕产妇死亡率降低四分之三和将五岁以下儿童死亡率降低三分之二方面。方法：本定量研究采用包含离散选择实验（DCE）的计算机化结构化调查来量化不同激励和政策的重要性，以鼓励高年级助产学生毕业后为贫困，农村和偏远地区服务。使用分层贝叶斯程序，我们估计了来自加纳两所最大的助产培训学校的298名助产学三年级学生的个人和平均效用参数。结果：我们样本中的助产学学生发现：1)在农村服务两年后学习休假；2)先进的工作环境，有可靠的电力、适当的技术和持续的药品供应；3)优越的住房条件（2卧室，1浴室，厨房，客厅，不共用）是接受农村工作的三大激励因素。结论：解决即将毕业并进入劳动力市场的助产学学生在农村工作的激励因素可能会对当前卫生人力分布不合理做出重大贡献。
Background: Mal-distribution of the health workforce with a strong bias for urban living is a major constraint to expanding midwifery services in Ghana. According to the UN Millennium Development Goals (MDG) report, the high risk of dying in pregnancy or childbirth continues in Africa. Maternal death is currently estimated at 350 per 100,000, partially a reflection of the low rates of professional support during birth. Many women in rural areas of Ghana give birth alone or with a non-skilled attendant. Midwives are key healthcare providers in achieving the MDGs, specifically in reducing maternal mortality by three-quarters and reducing by two-thirds the under 5 child mortality rate by 2015.Methods: 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. Using a hierarchical Bayes procedure we estimated individual and mean utility parameters for two hundred and ninety eight third year midwifery students from two of the largest midwifery training schools in Ghana.Results: Midwifery students in our sample identified: 1) study leave after two years of rural service; 2) an advanced work environment with reliable electricity, appropriate technology and a constant drug supply; and 3) superior housing (2 bedroom, 1 bathroom, kitchen, living room, not shared) as the top three motivating factors to accept a rural posting.Conclusion: Addressing the motivating factors for rural postings among midwifery students who are about to graduate and enter the workforce could significantly contribute to the current mal-distribution of the health workforce.