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

• Published in: BMC health services research Vol. 11; no. 1; p. 300
• Main Authors: Johnson, Jennifer C, Nakua, Emmanuel, Dzodzomenyo, Mawuli, Agyei-Baffour, Peter, Gyakobo, Mawuli, Asabir, Kwesi, Kwansah, Janet, Kotha, S Rani, Snow, Rachel C, Kruk, Margaret E
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03-11-2011; BioMed Central; BMC
• Subjects: Adult; Beliefs, opinions and attitudes; Career Choice; Career development planning; Careers; Charters; Colleges & universities; Cross-Sectional Studies; Data collection; Dependent variables; Education reform; Emigration; Female; Field study; Ghana; Health sciences; Health services; human resources for health; Humans; Incentives; Information management; Infrastructure; Low income groups; Male; Management styles; Marital status; medical doctors; Medical research; Medical students; Medicine; Monetary incentives; Motivation; Practice; Preferences; Public health; Rural areas; Rural Health Services - economics; Rural Health Services - organization & administration; rural incentives; rural practice; Salaries and Fringe Benefits; Schools; Science; Socioeconomic factors; Software; Students, Medical - psychology; Surveys; Urban areas; Variables; Workers; Working conditions; Young Adult; Ghana
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-11-300

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.
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.
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.
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.