Retention of Doctors and Dentists to Serve in Remote Areas in Indonesia: A Discrete Choice Experiment

Anna Kurniati,1 Ferry Efendi,2,3 Ismawiningsih Ismawiningsih,1 Nila Mulyani,1 Zakaria Zakaria,1 Retno Ambarwati,1 Hutomo Tuhu Prasetyo,1 Endro Muljandari,1 Irni Damayanti,1 Arif Yustian Maulana Noor,4 Lisa McKenna,3 Iin Nurlinawati5 1Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia; 2Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia; 3School of Nursing and Midwifery, La Trobe University, Melbourne, Australia; 4Agriculture Socio-Economic Department, Faculty of Agriculture, Brawijaya University, Malang, Indonesia; 5Badan Riset Inovasi Nasional, Jakarta, IndonesiaCorrespondence: Ferry Efendi, Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia, Tel +62 31 591 3754, Email ferry-e@fkp.unair.ac.idIntroduction: Retaining doctors and dentists in remote areas of Indonesia remains a national priority of the Indonesian government. The purpose of this study was to analyze the interventions for retention of doctors and dentists in remote areas using the discrete choice experiment (DCE) approach.Materials and Methods: A DCE was conducted to investigate preferences of doctors and dentists for retention in remote areas. This research was conducted in 78 primary healthcare settings across 15 provinces in Indonesia. The conditional logit model was used to explore stated preferences for each attribute.Results: The total number of respondents was 158, including 113 doctors and 45 dentists. In general, doctors placed the highest preference on getting priority for government scholarships to facilitate retention in remote areas (OR=5.65, p< 0.001). Specifically, dentists preferred security guarantees from local government (OR = 4.87, p< 0.001). Both groups valued having an official residence (OR=3.6, p< 0.001) as a factor for retention in remote areas.Conclusion: Scholarship, security guarantees, housing facilities, and medical facilities were the most considered factors for retaining doctors and dentists in a remote area. This study confirms the importance of a combination of interventions in maintaining doctors and dentists in remote areas. Policy options in the form of non-financial and financial intervention packages can be combined to improve their retention.Keywords: preferences, health systems, health workers, rural area, health workforces, DCE