Linking health worker motivation with their stated job preferences: A hybrid choice analysis in Ethiopia

Understanding health worker job preferences can help policymakers better align incentives to retain a motivated workforce in the public sector. However, in stated preference choice modelling, health worker motivation to do their jobs has not been incorporated, perhaps surprisingly, as an important antecedent to health worker job choices. This paper is the first application of a hybrid choice model to measure the extent to which variations in the job preferences of community health workers (CHWs) can be explained by multidimensional motivation. We interviewed 202 CHWs in Ethiopia in 2019. Motivation was assessed quantitatively using a series of thirty questions, on a five-point Likert scale. Stated preferences for hypothetical jobs were captured using an unlabelled discrete choice experiment. We estimated three models and explored which best fitted choice data. We found that the hybrid choice model fitted better than simpler choice models and provides additional behavioural insight into the preferences of CHWs. Intrinsically motivated CHWs had strong disutility towards a higher than average salary, but preferred good facility quality and good health outcomes. On the contrary, CHWs who were assessed to be extrinsically motivated had disutility attached to a heavy workload and preferred higher than average salaries. We show a link between heterogeneity in the job preferences of CHWs and their motivation, demonstrating that its important for policy makers and managers to understand this link in order to get health workers to exert more effort in return for the right incentives and to retain a motivated workforce in the long run.