Retention and motivation of health workers in remote and rural areas in Cross River State, Nigeria: a discrete choice experiment

Abstract

Background Cross River State is making investments geared towards ensuring equitable distribution and improved retention of its frontline health workforce in remote and rural areas. This informed the conduct of a discrete choice experiment to determine the motivating factors supporting the retention of healthcare workers. Methods Study participants were 198 final year students of nursing, midwifery and community health and frontline health workers. Eight focus group discussions and 38 key informant interviews were conducted to obtain information about the dimensions of the work conditions that are important to frontline health workers when choosing to take up posting or stay in their rural work locations. Results Health workers are 2.7 times more likely to take up a rural posting or continue to stay in their present rural duty posts if they receive a salary increment. They are also four times more likely to take a rural job posting if a basic housing or a housing allowance is provided. Conclusion Improving working conditions of frontline health workers in terms of adequate staff strength, good skills mix and equipment, etc., as well as improving opportunities for career advancement will support retention in rural health posts.

A Discrete Choice Experiment on Factors Influencing Attrition and Motivation of Frontline Health Workers in Remote and Rural Areas in Nigeria

“…The ndings of our study place a low utility on salary despite the literature indicating that an increase in salaries is important [32] and it often causes strike actions in Nigeria's health sector [16]. Studies have also shown that salaries and other factors including those bothering on working conditions are often implied in instances of unrest [11].…”

“…The current situation in Nigeria indicates that health workers are not motivated and this is negatively impacting their performance and e ciency. Several factors, including poor remuneration, inadequate sta ng levels with resultant high workloads, lack of social amenities, poor working environments, inadequate medical supplies and equipment, and delayed salaries and emoluments payment have been documented [8][9][10][11][12][13][14][15][16][17]. Additionally, institutionalized attraction, retention, posting, and motivation mechanisms are absent, especially for primary level facilities often located in rural and remote areas [6,18].…”

“…This informed this study using the discrete choice technique to ascertain the applicable combinations. This technique has been applied in several settings globally with essential evidence generated for policy and planning [11,[19][20][21][22].…”

Using the workload indicators of staffing need method to determine the staffing requirements for primary healthcare service delivery in Nigeria

“…These additional workloads are contributing to reported high workloads in the primary level of care and are considered by health workers when they plan to take up or stay in rural postings. 10,11,[22][23][24] Government should therefore put measures in place to ensure that there is an appropriate skill-mix of health workers to perform these functions.…”

“…[7][8][9] Health workers are facing poor remuneration, high workloads, poor working environments, inadequate medical supplies and equipment, and delayed payment of salaries and emoluments. 7,[10][11][12] The weak health governance mechanism compounded by inadequate numbers of health workers at the primary level of care, the entry point into Nigeria's health system, necessitates the need to ensure that staffing levels are informed by workloads. This study utilized the Workload Indicator for Staffing Needs (WISN) method 8 to determine the staffing needs in selected facilities in Cross Rivers State of Nigeria.…”