Nonglak Pagaiya, Thinakorn Noree, Viroj Tangcharoensathian, Mylene Lagarde and Chotiros Laongbua
International Health Policy Program, MOPH, Thailand

The vast majority of poor and disadvantaged patients live in rural areas where health services are least developed. A major constraint to improving the availability and quality of health care services in rural areas is that it has proven difficult to attract and retain skilled health workers in rural health facilities. The shortage of nurses in rural areas is a recurring concern in Thailand. Recently, it has been aggravated by two factors: an increase in health demand due to the increase of access to care as well as the transition of demographic and epidemiology situation; and inadequate workforce supply. Importantly, the number of newly graduated nurses who are the majority of health workforce entering rural health facilities has declined since the compulsory contract with the government has abolished in 2004 resulting from the public sector reform. Significant attention is being focused on health workforce strategies to address the problem but it is not clear which policy interventions would be most effective.

The overall aim of this research is to support the identification of more effective policy interventions that will improve the recruitment and retention of nurses in rural areas. Our study will investigate the attitudes, values, preferences and early career choices of nursing graduates in Thailand using Discrete Choice Experiments (DCE).

DCE involves asking nurses to indicate their preference about hypothetical job descriptions, where each job was characterized by 7 job attributes: facility type, salary, housing provision, medical benefit package, training, career upgrading and workplace management. Qualitative methods were used to identify the rang of job attributes using focus group discussion with 20 newly graduated nurses and 5 policy maker interview. 342 newly graduated nurses from 4 nursing colleges were included in the sample size. Each nurse was asked to consider 16 pairs of job descriptions and choose one job among each pair. The significant of job attributes was analysed using a random-effects probit estimator.

The results showed that 83% of newly graduated nurses have a rural background. Their main sources of financial support during their studentship were: parents (98%), loan (65%), and scholarship (26%), respectively. According to the DCE, all attributes were found to have a statistically significant effect on the utility associated with the employment alternatives. In stating preferences and making choices about different hypothetical jobs, newly graduated nurses were taking into account type of facilities, housing provision, medical benefit provision, training opportunity, career upgrading, workplace management as well as salary top-up.

The results imply that the Thai government has a range of interventions available that would attract newly graduated nurses to public and rural sector. Newly graduated nurses are likely to prefer to work at rural hospital rather than rural health centre, posting them at district hospital is likely to have a positive impact on how they value their employment. Moreover, housing provision and medical benefit provision for their families were considered important for substitution for their civil servant status. Faster career upgrading and rationale management atmosphere were likely to make rural facility more attractive. Salary top-up, though ranked among the last, found to be important attributes to attract nurse working in rural. However, in using the DCE, it should be noted that their decisions are made on hypothetical alternatives, therefore follow up for their actual choices is needed.
The 5th AAAH Conference, Bali