Abstract
Attracting, training and retaining high-quality health workers are critical for a health system to function well, and it is important to know what health workers value in their roles. Many studies eliciting the labour market preferences of health workers have interviewed doctors or medical students, and there has been little research on the job preferences of lower-skilled cadres such as community health workers, mid-skilled clinical care staff such as nurses and midwives, or non-patient facing staff who manage health facilities. This study estimated the job preferences of public health sector community health extension workers (HEWs), care providers including nurses and midwives, and non-patient-facing administrative and managerial staff in Ethiopia. We used a discrete choice experiment to estimate which aspects of a job are most influential to health worker choices. A multinomial logistic regression model estimated the importance of six attributes to respondents: salary, training, workload, facility quality, management and opportunities to improve patient outcomes. We found that non-financial factors were important to respondents from all three cadres: e.g., supportive management [odds ratio (OR) = 2.96, P-value = 0.001] was the only attribute that influenced the job choices of non-patient-facing administrative and managerial staff. Training opportunities (OR = 3.45, P-value < 0.001), supportive management (OR = 3.26, P-value < 0.001) and good facility quality (OR = 2.42, P-value < 0.001) were valued the most amongst HEWs. Similarly, supportive management (OR = 3.22, P-value < 0.001), good facility quality (OR = 2.69, P-value < 0.001) and training opportunities (OR = 2.67, P-value < 0.001) influenced the job choices of care providers the most. Earning an average salary also influenced the jobs choices of HEWs (OR = 1.43, P-value = 0.02) and care providers (OR = 2.00, P-value < 0.001), which shows that a combination of financial and non-financial incentives should be considered to motivate health workers in Ethiopia.
Highlights
Motivation and retention of health workers are a key challenge in low- and middle-income countries (LMICs)—some of which face severe human resource shortages (Chen et al, 2004; World Health Organization, 2006; 2016)
We found that non-financial factors were important to respondents from all three cadres: e.g., a supportive management style was found to be the most important attribute across all cadres in Ethiopia including health extension workers (HEWs), care providers and non-patient-facing administrative and managerial staff
Non-patient-facing administrative and managerial staff had the highest qualifications amongst the three sub-groups, of whom 50% (22/43) had a bachelors’ degree and earned a gross salary above the whole sample average (ETB 5669 per month which was equivalent to 206 US dollar (USD))
Summary
Motivation and retention of health workers are a key challenge in low- and middle-income countries (LMICs)—some of which face severe human resource shortages (Chen et al, 2004; World Health Organization, 2006; 2016). It is presumed that health workers are motivated by an overall desire to improve patient outcomes (Lindelow and Serneels, 2006). The majority of DCE studies for health workforce policy have focused on the labour preferences of qualified doctors and medical students (Mandeville et al, 2014). There has been little research conducted on the job preferences of lower-skilled cadres such as community health workers, mid-skilled clinical care staff such as nurses and midwives, or non-patient-facing administrative and managerial staff that largely manage health facilities (Mandeville et al, 2014)
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