Stated job preferences of three health worker cadres in Ethiopia: a discrete choice experiment

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.