Addressing Concerns of Access and Distribution of Health Workforce: A Discrete Choice Experiment to Develop Rural Attraction and Retention Strategies in Southwestern Ethiopia.

Abstract

Abstract Background: There exists a shortage of healthcare workers in Ethiopia, with an uneven distribution between urban and remote areas. To formulate effective policy intervention aimed at attracting and retaining health workers in remote regions, this study examines the stated preferences of health workers when selecting health jobs. Methods: A Discrete Choice Experiment was conducted with health workers in the Aari and South Omo Zone of the South Ethiopia region from September to November 2022 to gather insights into their job preferences. After conducting literature review, focus group discussions and in-depth interviews salary, education, housing, location, timeliness of payment, medicine and equipment, management culture, and infrastructure attributes included in the study. To assess the relative importance of these job attributes and account for heterogeneity in preferences and scales, I used a mixed logit model with full correlation between utility coefficients. I conducted willingness to pay analysis using delta method and probability of job uptake for single incentive and combination of incentives based on results from the mixed logit model. Results: All eight attributes were statistically significant with the expected signs and demonstrated the existence of preference heterogeneity. Education, salary, and housing were of most concern to health workers when deciding their future workplace. Health workers are willing to trade a significant portion of their salary for improvements in other aspects of the job. Sub-group analysis showed that health workers with no rural background were willing to pay more to work at the zone center than health workers who lived in rural area for more than a year. The probability to work in rural area increases by 61% if education is offered to health workers after one year of service. Cost-effectiveness analysis revealed that raising salary is the most cost-effective incentive to attract and retain health workers. However, packages of incentives are always preferred over single incentive. Conclusion: Health workers express willingness to relocate to or continue serving in rural and remote areas, contingent upon improved working conditions Both monetary and non-monetary policy interventions should be considered by policymakers to attract and retain health workers to distant locations of southwestern Ethiopia.