Attracting low level trained health workers in the rural areas: insights from discrete choice experiment

Abstract

Background: One of the biggest challenges that policy makers face in the health sector in Tanzania is how to attract qualified human resources to the rural and remote parts of Tanzania. Currently the government has been able to only employ 35% of needed work force. The distribution of the employed health workers is characterized by geographical imbalance, attributed by reluctance to work in remote and rural. In addressing the gap, the government has increased training of lower carder health workers. However, less is known on how the newly trained lower carders would respond to known job attributes(incentiveswhile eliciting choices for particular place; particularly their attraction to rural and remote areas. Objective: To determine the important financial and non-financial incentives that would attract low level trained health workers to work in rural and remote areas. Methodology: A cross sectional explorative study using experimental economics design of discrete choices was conducted among 195 Low level final year students at Musoma Clinical Assistants School, Tarime and Geita Nursing Schools. The study investigated the incentive (attributes) package that attracts low level trained health workers in rural areas. A multivariate binary logit model was used to estimate the extent to which Low level trained health workers were willing to tradeoff between the five job attributes (net monthly pay, provision of basic housing, opportunities to upgrade their qualifications, availability of medicines and other supplies and good leadership and management) and the selection of either rural or urban job. Results: Most Low Level Trained Health workers‟ were willing to tradeoff job attributes in favor of provision of upgrading training in exchange of a rural job, OR=0.83(0.7- 11), with P value =0.037, had statistically significant influence on Low Level trained health workers‟ preferences. Further analysis of sub-groups showed almost similar results, with significantly influencing selection of rural jobs by students who resides in rural areas. Ranking of the attributes by using simple ordering and the DCE models, ware not statistically different, P-values = 1.573. Conclusions: Provision of upgrading training is more likely to attract to Low Level health workers to work in rural areas. However combining provision of training with increase in net monthly pay and/ or availability of medicines can enhance the chances of low level health workers tochoose a rural job.