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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.

This study unlike many others, which interview doctors or medical students,  aimed to understand 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.

The study, authored by members of the IDEAS team, employed 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.

Two health workers prepare medication at Addis Kidam health post in Ethiopia.
Photo: IDEAS/Christopher Smith 2019

Findings show that non-financial factors were important to respondents from
all three cadres: e.g., supportive management was the only attribute that influenced the job choices of non-patient-facing administrative and managerial staff. Training opportunities, supportive management and good facility quality were valued the most amongst health extension workers. Similarly, supportive management, good facility quality and training opportunities influenced the job choices of care providers the most. Earning an average salary also influenced the jobs choices health extension workers and care providers, which shows that a combination of financial and non-financial incentives should be considered to motivate health workers in Ethiopia.

Authors

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Matthew Quaife

Assistant Professor

Shyam Lamba

Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine

Nikita Arora

Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine

Dorka Woldesenbet Keraga

School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia

Abiyou Kiflie

Institute for Healthcare Improvement, Addis Ababa, Ethiopia

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Dr Della Berhanu

Former IDEAS Ethiopia Country Coordinator and Research Fellow

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Mehret Dubale

Research Fellow

Profile picture of Dr Tanya Marchant
Dr Tanya Marchant

IDEAS Principal Investigator and Associate Professor

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Professor Joanna Schellenberg

IDEAS Co-Principal Investigator and Professor

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Dr Nasir Umar

IDEAS Nigeria Country Coordinator and Research Fellow

Abiy Seifu Estafinos

School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia

Birkety Mengistu Jembere

Institute for Healthcare Improvement, Addis Ababa, Ethiopia