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Open Access Research article

For money or service? a cross-sectional survey of preference for financial versus non-financial rural practice characteristics among ghanaian medical students

Jennifer C Johnson1*, Emmanuel Nakua2, Mawuli Dzodzomenyo3, Peter Agyei-Baffour4, Mawuli Gyakobo5, Kwesi Asabir6, Janet Kwansah7, S Rani Kotha8, Rachel C Snow9 and Margaret E Kruk10

Author Affiliations

1 University of Michigan Center for Global Health, Galleria Building, 1214 S. University Ave, 2nd Floor Suite C, Ann Arbor, Michigan 48104 USA

2 Kwame Nkrumah University of Science and Technology, Department of Community Health, PMB, Kumasi, Ghana, West Africa

3 University of Ghana School of Public Health, Department of Biological, Environmental and Occupational Health Sciences, PO Box LG 13, University of Ghana, Legon, Ghana

4 Kwame Nkrumah University of Science and Technology, Department of Community Health, Kumasi, Ghana

5 University of Ghana, c/o Office of the Provost, College of Health Sciences, University of Ghana, PO Box KB 52, Korle Bu, Ghana

6 Ministry of Health, Human Resource for Health Directorate, P.O.Box M44, Accra, Ghana

7 Ministry of Health, Policy, Planning, Monitoring, and Evaluation Directorate, PO Box M44, Accra, Ghana

8 University of Michigan Center for Global Health, Galleria Building, 1214 S. University Ave, 2nd Floor Suite C, Ann Arbor, Michigan 48104 USA

9 University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights 3814 SPH I, Ann Arbor, Michigan 48109 USA

10 Columbia University Mailman School of Public Health, 600 W. 168th Street, Room 606, New York, NY 10032

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BMC Health Services Research 2011, 11:300  doi:10.1186/1472-6963-11-300

Published: 3 November 2011

Abstract

Background

Health worker shortage and maldistribution are among the biggest threats to health systems in Africa. New medical graduates are prime targets for recruitment to deprived rural areas. However, little research has been done to determine the influence of workers' background and future plans on their preference for rural practice incentives and characteristics. The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana.

Methods

We asked fourth-year Ghanaian medical students to rank the importance of rural practice attributes including salary, infrastructure, management style, and contract length in considering future jobs. We used bivariate and multivariate ordinal logistic regression to estimate the association between attribute valuation and students' socio-demographic background, educational experience, and future career plans.

Results

Of 310 eligible fourth year medical students, complete data was available for 302 students (97%). Students considering emigration ranked salary as more important than students not considering emigration, while students with rural living experience ranked salary as less important than those with no rural experience. Students willing to work in a rural area ranked infrastructure as more important than students who were unwilling, while female students ranked infrastructure as less important than male students. Students who were willing to work in a rural area ranked management style as a more important rural practice attribute than those who were unwilling to work in a rural area. Students studying in Kumasi ranked contract length as more important than those in Accra, while international students ranked contract length as less important than Ghanaian students.

Conclusions

Interventions to improve rural practice conditions are likely to be more persuasive than salary incentives to Ghanaian medical students who are willing to work in rural environments a priori. Policy experiments should test the impact of these interventions on actual uptake by students upon graduation.

Keywords:
human resources for health; Ghana; rural practice; emigration; rural incentives; medical doctors