Rural practice preferences among health workers in selected health facilities in Lusaka, Chibombo, and Chongwe districts in Zambia: a discrete choice experiment

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Zulu, Leonard Mangani
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University of Zambia
The shortage of health workers in the areas where they are most needed is a significant problem for health systems. Over the past decade, countries have introduced strategies to address the unequal distribution of health workers in rural and remote are evad.e nce to date on the effectiveness of these interventions is only moderate at best (WHO, 2014). Discrete Choice Experiments (DCE) presents an effective way for evaluating the effectiveness of these strategies (Rockers et al., 2012 ). The study used Disrecte Choice Experiments method (DCE); a quantitative technique for eliciting individual’s preferences. This technique helps to uncover how individuals’ value particular attributes of an alternative by asking them to state their preferred choice over hypothetical alternatives. The methodology represents an integration of several theoretical areas, mainly the random utility framework. They are also consistent with Lancaster’s characteristics theory of demand which argues that consumers have preferencesd fodre raivne utility from attributes, rather than goods per se. Using a DCE, this study sought to estimate the relative importance of different job attributes for health worker’s in Chibombo. Chongwe, and Lusaka districts preference to work in rural areas, tthraede-off among these job attributes, and the total satisfaction or benefits respondents derive from working in rural a reas. A total of 355 sel-fadministered questionnaires were distributed, of which 353 were returned (response rate 99%). The study foutnhda t respondents prefer salary increment, training/career development, support from the manager, housing and quality of facility as part of their incentive package. In particular, Salary increases the preference of working in the rural areas by 3.5, providing training by 0.43, support from the manager by 0.46, providing housing by 0.57 and the quality of facility by 0.54. Further, Respondents were give up 20% of their salary given housing was provided, 15% of their salary for a more improved quality off atchieli ty and 10% of their salary for supportive management. Assuming that we want to improve preference to work in rural areas, an incentive package that includes provision of training, supportive management, increased salary, provision of housing and iomvperd quality of facilities gives the highest benefit score of 2.89 with aans sociated cost increase of 82 per.c ent Keywords: Discrete Choice Experiment, Health workers, Utility
Health workers--Rural areas