Abstract
Although the factors influencing the shortage and maldistribution of health workers have been well-documented by cross-sectional surveys, there is less evidence on the relative determinants of health workers' job choices, or on the effects of policies designed to address these human resources problems. Recently, a few studies have adopted an innovative approach to studying the determinants of health workers' job preferences. In the absence of longitudinal datasets to analyse the decisions that health workers have actually made, authors have drawn on methods from marketing research and transport economics and used Discrete Choice Experiments to analyse stated preferences of health care providers for different job characteristics.We carried out a literature review of studies using discrete choice experiments to investigate human resources issues related to health workers, both in developed and developing countries. Several economic and health systems bibliographic databases were used, and contacts were made with practitioners in the field to identify published and grey literature.Ten studies were found that used discrete choice experiments to investigate the job preferences of health care providers. The use of discrete choice experiments techniques enabled researchers to determine the relative importance of different factors influencing health workers' choices. The studies showed that non-pecuniary incentives are significant determinants, sometimes more powerful than financial ones. The identified studies also emphasized the importance of investigating the preferences of different subgroups of health workers.Discrete choice experiments are a valuable tool for informing decision-makers on how to design strategies to address human resources problems. As they are relatively quick and cheap survey instruments, discrete choice experiments present various advantages for informing policies in developing countries, where longitudinal labour market data are seldom available. Yet they are complex research instruments requiring expertise in a number of different areas. Therefore it is essential that researchers also understand the potential limitations of discrete choice experiment methods.
Highlights
The importance of human resources for health systems is demonstrated by ecological evidence of a positive correlation between the population density of health care providers in a country and the coverage achieved for costeffective health interventions such as immunization or skilled attendance at delivery [1,2]
It is widely acknowledged that adequate health care delivery depends on the performance of the health workforce, which is determined by the availability, competence, productivity and responsiveness of health workers [4]
Methods used for the review Papers were primarily identified through a search of the following databases: Popline, PubMed, Econlit, HEED (Health Economics Evaluation Database), Emerald and Business Source Premier
Summary
The importance of human resources for health systems is demonstrated by ecological evidence of a positive correlation between the population density of health care providers in a country and the coverage achieved for costeffective health interventions such as immunization or skilled attendance at delivery [1,2]. Evidence on the effectiveness of these non-financial interventions is limited [20] and HR problems persist everywhere. To better address these issues and craft adequate policy interventions, there is a need for further investigation into the nature and determinants of health workers' job choices. Current policy initiatives in many countries are hampered by the dearth of objective empirical data on health worker flows and behaviours, the determinants of their choices and the implications of these dynamics in terms of policy [20]
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