Addressing concerns of access and distribution of health workforce: a discrete choice experiment to develop rural attraction and retention strategies in southwestern Ethiopia.

backgroundThere is a shortage of health workers in Ethiopia, with an uneven distribution between urban and rural areas. To formulate effective policy interventions aimed at attracting and retaining health workers in rural regions, this study examined the stated preferences of health workers when selecting health jobs.

methodsA discrete choice experiment was conducted among health workers in the Aari and South Omo zones of the South Ethiopia region, from September to November 2022 to gather insights into their job preferences. The design of the discrete choice experiment was informed by literature review, focus group discussions, and in-depth interviews. Through these qualitative studies, key job attributes influencing health workers' preferences were identified, including salary, education, housing, location, timeliness of payment, medicine and equipment, management culture, and infrastructure. We employed a mixed logit model, allowing for full correlation between utility coefficients, to assess the relative importance of these attributes and account for heterogeneity in preferences and scales. We also conducted a willingness-to-pay analysis and assessed the probability of job uptake for both single and combined incentives.

resultsAll eight attributes exhibited statistically significant effects, with the expected signs, and indicating preference heterogeneity. Education opportunity, salary, and housing emerged as the most influential attributes shaping health workers' decisions when considering a rural posting as a future workplace. Notably, health workers were willing to trade off a significant portion of their salary for improvements in other aspects of the job. Subgroup analysis revealed that health workers without a rural background were willing to pay more to work at the relatively more urban zone center compared to those with rural experience. Offering educational opportunities after one year of service at the base salary increased the probability of choosing a rural job posting by 79.8%. In addition, we find that packages of incentives are usually preferred over a single incentive.

conclusionHealth workers express a willingness to relocate to or continue serving in rural areas contingent upon improved working conditions. Both monetary and non-monetary policy interventions should be considered by policymakers to attract and retain health workers at rural locations in southwestern Ethiopia.