Incentives for non-physician health professionals to work in the rural and remote areas of Mozambique—a discrete choice experiment for eliciting job preferences

BACKGROUND: Successfully motivating and retaining health workers is critical for the effective performance of health systems. In Mozambique, a shortage of health care professionals and low levels of staff motivation in rural and remote areas pose challenges to the provision of equitable health care delivery. This study provides quantitative information on the job preferences of non-physician health professionals in Mozambique, examining how different aspects of jobs are valued and how health professionals might respond to policy options that would post them to district hospitals in rural areas. METHODS: The study used a discrete choice experiment (DCE) to elicit the job preferences of non-physician health professionals. Data collection took place in four Mozambique provinces: Maputo City, Maputo Province, Sofala and Nampula. DCE questionnaires were administered to 334 non-physician health professionals with specialized or university training (‘mid-level specialists’ and N1 and N2 categories). In addition, questionnaires were administered to 123 N1 and N2 students to enable comparison of the results for those with work experience with those without and determine how new N1 and N2 graduates can be attracted to rural posts. RESULTS: The results indicate that the provision of basic government housing has the greatest impact on the probability of choosing a job at a public health facility, followed by the provision of formal education opportunities and the availability of equipment and medicine at a health facility. The sub-group analysis suggests that job preferences vary according to stage of life and that incentive packages should vary accordingly. Recruitment strategies to encourage non-clinical professionals to work in rural/remote areas should also consider birthplace, as those born in rural/remote areas are more willing to work remotely. CONCLUSION: The study was undertaken within an overarching project that aimed to develop incentive packages for non-physician health professionals assigned to work in remote/rural areas. Based on the DCE results, the project team, together with the Mozambique Ministry of Health, has developed a range of health workforce retention strategies focusing on the provision of housing benefits and professional development opportunities to be utilized when assigning non-physician health professionals to rural/remote areas.