Health Worker Preferences for Job Attributes in Ethiopia : Results of a Discrete Choice Experiment

Like many other countries in sub-Saharan Africa, Ethiopia's human resource problems are impeding progress towards global health targets. These include difficulties of attracting health workers into public service employment, retaining them, and ensuring an equitable distribution between urban and rural locations. While increasing the wage level is one possible response, it is not clear that this would be sufficient: other financial and non-financial incentives could also be used to attract, retain and motivate doctors and nurses. This paper presents the results of a discrete choice experiment administered in a cross-sectional survey of about 1,000 health workers (about 350 doctors and 650 nurses) in Addis Ababa and two remote regions (Tigray and SNNPR) to assess health worker preferences over job characteristics. Six attributes are examined (pay, housing, location, access to training, availability of drugs and supplies, access to private practice (for doctors), and degree of supervision (nurses). A random effects probit model is used to estimate the marginal utilities associated with each attribute, and their relative importance is assessed by estimating the marginal rates of substitution between increased salary and each of the non-salary attributes. Interactions between preferences and socio-demographic characteristics of respondents are explored. Results for nurses and doctors are compared, and the implications of the findings for human resources policies are discussed