Job Preferences of Frontline Health Workers in Ghana - A Discrete Choice Experiment

The lack of supply of adequately skilled and motivated health workers especially in rural areas poses a major obstacle to health service delivery in Ghana, as well as in many other developing countries. In this paper, we present the results of a discrete choice experiment (DCE) conducted with community health officers (CHO) and community health volunteers (CHV), which are extension workers that provide health services and consultations to mostly rural populations. CHOs and CHVs completed the cadre-specifi?c discrete choice experiment that elicited preferences for attributes of potential job postings. Data was collected from 404 CHOs and 206 CHVs in 8 Ghanaian districts in 4 regions. For CHOs, next to increases in salary, the choice of job posting was most strongly influenced by facility quality, followed by career development opportunities and transport subsidies. Additional supervision showed no effects. For CHVs, next to receiving a monthly stipend, facility quality was also most important, followed by training opportunities. We are corroborating the notion that other non-fi?nancial incentives can have strong effects on job preferences, for example the equipment of the facilities, which includes housing, as well as training and career development and training opportunities. Given that Ghana's health wage bill is already very high (in relative terms), this may open new policy avenues for health worker recruitment and retention to converge towards universal health coverage.