IFGH 2012: An Investigation of the Job Preferences of Mid-Level Healthcare Providers in Sub- Saharan Africa: Results from Large Sample Discrete Choice Experiments in Malawi, Mozambique and Tanzania

January 30, 2012

Authors:McAuliffe E.1, Revill P.2, Kamwendo F.3, Sidat M.4, Masanja H.5, dePinho H.6, Araujo E.7

Author Affiliations:1Centre for Global Health, University of Dublin, Trinity College, 2Centre for Health Economics, University of York, 3University of Malawi, College of Medicine, Centre for Reproductive Health, Malawi, 4Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Mozambique, 5IIfakara Health Institute, Mikocheni, Dar Es Salaam, Tanzania, 6Averting Maternal Death and Disability Program (AMDD), Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, USA, 7Health, Nutrition and Population Programme, World Bank, Washington DC

Option 1 –Scientific / Empirical Research Findings Presented as – Oral Presentation


The use of mid-level providers (MLPs) (trained and deployed in 25 African countries) is one key strategy to providing quality EmOC, thereby reducing maternal and neonatal deaths. The range of factors influencing the motivation and retention of MLPs and other health workers now appears to be relatively well understood. Less well known however is the relative importance of the different factors in determining motivation and retention. Although previous work has examined the job preferences of health workers in sub-Saharan Africa this has often excluded attributes (e.g. human resources management (HRM)) which exploratory work has shown to be crucial. This study addresses the gaps in the extant literature by focusing on MLPS (cadres that are providing the majority of healthcare) and by including potentially important motivators such as HRM and professional development (CPD). In addition the study comprises a large sample across three countries, where the majority of previous studies are single country studies.


This paper presents findings from DCEs with 2,072 health workers working in the public health systems in Malawi, Mozambique and Tanzania. The primary target for the DCE was health workers involved in the delivery of emergency obstetric care. Each respondent was asked to evaluate 15 choice sets and choose one job description; each choice set containing two job.


The results are consistent across the countries, the strongest predictors of job choice being access to CPD and HRM. We found pay to be important and significantly positively related to utility, but financial rewards are not as fundamental a factor in employment preferences as many may have previously believed. There is evidence to indicate diminishing marginal utility in relation to pay in all three countries.

Discussion/conclusions/ implications:

Recruitment and retention of health workers can be strongly influenced by improving human resources management and access to professional development.



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