For more than money: willingness of health professionals to stay in remote Senegal

Ayako Honda (Corresponding Author), Nicolas Krucien, Mandy Ryan, Ibrahima Ska Ndella Diouf, Malick Salla, Mari Nagai, Noriko Fujita

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Poor distribution of already inadequate numbers of health professionals seriously constrains equitable access to health services in low- and middle-income countries. The Senegalese Government is currently developing policy to encourage health professionals to remain in areas defined as ‘difficult’. Understanding health professional’s preferences is crucial for this policy development.

Working with the Senegalese Government, a choice experiment (CE) was developed to elicit the job preferences of physicians and non-physicians. Attributes were defined using a novel mixed-methods approach, combining interviews and Best-Worst Scaling (Case 1). Six attributes were categorised as ‘individual (extrinsic) incentive’ attributes (‘type of contract’, ‘provision of training opportunities’, ‘provision of an allowance’, and ‘provision of accommodation’) or ‘functioning health system’ attributes (‘availability of basic equipment in health facilities’ and ‘provision of supportive supervision by health administrators’). Using face-to-face interviews, the CE was administered to 55 physicians (3,909 observations) and 246 non-physicians (17,961 observations) randomly selected from those working in eight ‘difficult’ regions in Senegal. Conditional logit was used to analyse responses. This is the first CE to both explore the impact of contract type on rural retention and to estimate value of attributes in terms of willingness-to-stay (WTS) in current rural post.

For both physicians and non-physicians, a permanent contract is the most important determinant of rural job retention, followed by availability of equipment and provision of training opportunities. Retention probabilities suggest that policy reform affecting only a single attribute is unlikely to encourage health professionals to remain in ‘difficult’ regions. The relative importance of an allowance is low, however the level of such financial incentives requires further investigation.

Contract type is a key factor impacting on retention. This has led the Senegalese Health Ministry to introduce a new rural assignment policy that recruits permanent staff from the pool of annually contracted healthcare professionals on the condition that they take up rural posts. While this is a useful policy development, further efforts to retain rural health workers, considering both personal incentives and the functioning of health systems, are necessary to ensure health worker numbers are adequate to meet the needs of rural communities.
Original languageEnglish
Article number28
JournalHuman Resources for Health
Publication statusPublished - 25 Apr 2019

Bibliographical note

The study was funded through a Research Grant for International Health, H25-11, from the Ministry of Health, Welfare and Labour, Japan (, and undertaken as part of the project Réseau Vision Tokyo 2010, funded by the Japan International Cooperation Agency.

The authors would like to express their profound gratitude to the fieldwork team and to the health professionals who responded to the survey questionnaire. Thanks also to four reviewers whose comments have improved the paper.

The datasets used and/or analysed in the study are available from the corresponding author on reasonable request.


  • rural job retention
  • human resources for health
  • motivation
  • incentives
  • low- and middle- income countries
  • Senegal
  • discrete choice experiment
  • Human resources for health
  • Incentives
  • Rural job retention
  • Low- A nd middle-income countries
  • Motivation
  • Discrete choice experiment
  • Low- and middle-income countries


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