PT - JOURNAL ARTICLE AU - Blake Angell AU - Mushtaq Khan AU - Mir Raihanul Islam AU - Kate Mandeville AU - Nahitun Naher AU - Eleanor Hutchinson AU - Martin McKee AU - Syed Masud Ahmed AU - Dina Balabanova TI - Incentivising doctor attendance in rural Bangladesh: a latent class analysis of a discrete choice experiment AID - 10.1136/bmjgh-2021-006001 DP - 2021 Jul 01 TA - BMJ Global Health PG - e006001 VI - 6 IP - 7 4099 - http://gh.bmj.com/content/6/7/e006001.short 4100 - http://gh.bmj.com/content/6/7/e006001.full SO - BMJ Global Health2021 Jul 01; 6 AB - Objective Doctor absenteeism is widespread in Bangladesh, and the perspectives of the actors involved are insufficiently understood. This paper sought to elicit preferences of doctors over aspects of jobs in rural areas in Bangladesh that can help to inform the development of packages of policy interventions that may persuade them to stay at their posts.Methods We conducted a discrete choice experiment with 308 doctors across four hospitals in Dhaka, Bangladesh. Four attributes of rural postings were included based on a literature review, qualitative research and a consensus-building workshop with policymakers and key health-system stakeholders: relationship with the community, security measures, attendance-based policies and incentive payments. Respondents’ choices were analysed with mixed multinomial logistic and latent class models and were used to simulate the likely uptake of jobs under different policy packages.Results All attributes significantly impacted doctor choices (p<0.01). Doctors strongly preferred jobs at rural facilities where there was a supportive relationship with the community (β=0.93), considered good attendance in education and training (0.77) or promotion decisions (0.67), with functional security (0.67) and higher incentive payments (0.5 per 10% increase of base salary). Jobs with disciplinary action for poor attendance were disliked by respondents (−0.63). Latent class analysis identified three groups of doctors who differed in their uptake of jobs. Scenario modelling identified intervention packages that differentially impacted doctor behaviour and combinations that could feasibly improve doctors’ attendance.Conclusion Bangladeshi doctors have strong but varied preferences over interventions to overcome absenteeism. We generated evidence suggesting that interventions considering the perspective of the doctors themselves could result in substantial reductions in absenteeism. Designing policy packages that take account of the different situations facing doctors could begin to improve their ability and motivation to be present at their job and generate sustainable solutions to absenteeism in rural Bangladesh.All data relevant to the study are included in the article or uploaded as supplementary information. We have included all data relevant to the analysis in the manuscript. As envisaged in our data management plan, we cannot make the raw data fully open access due to its highly sensitive nature. But we are making the data available to our collaborators’ institutions for further analysis, for example, for PhD theses.