Why Would I Go There? Motivating Workers to Take and Keep Jobs in Rural Areas

Given the complexity of the social, professional, and economic factors that influence motivation, how do institutions make rural job postings more attractive? While many recognize that salary is an important factor, other characteristics of a job—such as better living or working conditions, supportive supervision, opportunities for continuing professional development, career advancement, networking, and even public recognition—can improve a worker’s sense of purpose and productivity. Identifying and offering the right incentive package to workers can result in a win-win situation, with benefits for both the worker and the community served. To address this issue of job attraction and retention in the health sector, CapacityPlus has helped ministries of health and NGOs answer these questions by using a rapid discrete choice experiment, a rigorous survey method that identifies the trade-offs that workers would be willing to make between specific job characteristics. Garnering statistical evidence of what motivates workers provides policy-makers with the needed information to develop more cost-effective job incentive strategies. This article originally appeared in the December 2012 issue of Monthly Developments Magazine (

User Guide with Case Studies: How to Conduct a Discrete Choice Experiment for Health Workforce Recruitment and Retention in Remote and Rural Areas

Understanding why health workers want or don’t want to take posts and remain in remote and rural areas is a prerequisite to formulating appropriate policy responses to the shortage of health workers in these areas. Building on the World Health Organization (WHO) Guidelines on Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention, this user guide proposes an innovative methodology, the discrete choice experiment (DCE), to measure the strength of health workers’ preferences and trade-offs related to different job characteristics that can influence their decision to take up rural postings. The user guide offers step-by-step advice on the application of DCE to identify policy interventions appropriate to a particular country context. The guide is the product of close collaboration among three agencies—the World Bank, the WHO, and USAID/CapacityPlus—and represents their shared commitment to supporting policy-relevant research on critical topics related to human resources for health.

Designing Evidence-Based Incentives to Attract and Retain Health Workers Using the Rapid Retention Survey Toolkit

This eLearning course produced by CapacityPlus’s HRH Global Resource Center is based on CapacityPlus's Rapid Retention Survey Toolkit: Designing Evidence-Based Incentives for Health Workers. The course trains participants on how to use a rapid discrete choice experiment methodology to design evidence-based incentives to attract and retain health workers in rural and remote areas.

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Rapid Retention Survey Toolkit: Designing Evidence-Based Incentives for Health Workers

Rapid Retention Survey ToolkitThe Rapid Retention Survey Toolkit is designed to help countries determine what would motivate health workers to accept and remain in rural posts. It builds on the World Health Organization global policy recommendations for rural retention and is based on the discrete choice experiment (DCE), a powerful research method that identifies the trade-offs professionals are willing to make between specific job characteristics and determines their preferences for various incentive packages, including the probability of accepting a post in a rural facility. Employing a simplified version of the DCE methodology, the toolkit guides HR managers through the survey process to quickly assess health students’ and health workers’ motivational preferences to accept a position and continue working in underserved facilities. The results can be used to create evidence-based incentive packages that are appropriate within a country’s health labor market. Read more »

Designing Evidence-Based Incentive Strategies for Health Worker Retention

Many countries struggle to attract and retain sufficient numbers and types of health workers to provide quality services in rural and remote areas. Ministries of health often rely on external partners to develop the evidence base for formulating retention strategies, use less rigorous methodologies, or forego data altogether when making policy decisions. Presented at the Second Global Symposium on Health Systems Research in Beijing on November 1, 2012, this poster describes two new tools—the Rapid Retention Survey Toolkit and the iHRIS Retain costing tool for retention interventions—and related results from Ministry of Health surveys in Lao People’s Democratic Republic and Uganda.

iHRIS Retain

iHRIS Retain is an open source tool to cost health worker retention interventions. People living in rural and remote areas need more skilled health workers to care for their communities. However, attracting and retaining health workers to serve in these areas is a challenge. Developed by CapacityPlus in collaboration with the World Health Organization (WHO), iHRIS Retain is based on the WHO’s 2010 global policy recommendations on retention, which offer guidance on the different interventions in the areas of education, regulation, financial incentives, and professional development that can increase access to health workers in remote and rural areas through improved retention. iHRIS Retain guides users through the costing process step by step, collecting necessary data, calculating the costs of interventions, and comparing costs to available funding. The resulting information can then be used to develop retention strategies at the district, regional, or national level.

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Preferences for Working in Rural Clinics among Trainee Health Professionals in Uganda: A Discrete Choice Experiment

In low-income countries, failure to attract and retain health workers in rural areas reduces population access to health services and undermines facility performance, resulting in poor health outcomes. This article in BMC Health Services Research presents findings from CapacityPlus’s study on preferences for job characteristics among final-year medical, nursing, pharmacy, and laboratory students at select universities in Uganda. The findings contribute to mounting evidence that salary is not the only important factor health workers consider when deciding where to work.

Holding Health Workers Accountable: Governance Approaches to Reducing Absenteeism

Health workforce absenteeism is a serious problem and can greatly diminish the effectiveness of health service delivery. Reducing absenteeism requires a decentralized approach involving broad stakeholder groups to address underlying governance issues and reinforce complementary accountability mechanisms. This technical brief looks at the cost of absenteeism, examines governance issues, describes the various stakeholders, and offers a number of recommendations for strengthening governance to reduce absenteeism.

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Toward Development of a Rural Retention Strategy in Lao People’s Democratic Republic: Understanding Health Worker Preferences

This technical report presents the results of a discrete choice experiment (DCE) conducted by the Lao People’s Democratic Republic Ministry of Health, in partnership with the World Health Organization and CapacityPlus, using CapacityPlus’s rural retention survey toolkit. The DCE surveyed health professional students and health workers practicing in rural provinces to investigate their motivational preferences for potential strategies to increase attraction and retention in the country’s rural and remote settings.

iHRIS Retain: A Tool to Cost Retention Strategies

An overview of iHRIS Retain, a user-friendly tool to cost retention strategies to be implemented at the district, regional, or national level.

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