Addressing health workforce distribution concerns: a discrete choice experiment to develop rural retention strategies in

Background: Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH) is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas. Methods: To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE) was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data. Results: Among medical and nursing students a rural retention bonus of 75 % of base salary (aOR = 8.27, 95 % CI: 5.28-12.96, P< 0.001) and improved health facility infrastructure (aOR = 3.54, 95 % CI: 2.73-4.58) respectively were the attributes with the largest effect sizes. Among medical doctors and nurse aides, a rural retention bonus of 75% of base salary was the attribute with the largest effect size (medical doctors aOR = 5.60, 95 % CI: 4.12-7.61, P< 0.001; nurse aides aOR = 4.29, 95 % CI: 3.11-5.93, P< 0.001). On the other hand, improved health facility infrastructure (aOR = 3.56, 95 % CI: 2.75-4.60, P< 0.001), was the attribute with the largest effect size among the state registere