Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
School of Public Health, Addis Ababa University, P.O. Box: 9086, Addis Ababa, Ethiopia.
Health Policy Plan. 2021 Oct 12;36(9):1418-1427. doi: 10.1093/heapol/czab081.
Attracting, training and retaining high-quality health workers are critical for a health system to function well, and it is important to know what health workers value in their roles. Many studies eliciting the labour market preferences of health workers have interviewed doctors or medical students, and there has been little research on the job preferences of lower-skilled cadres such as community health workers, mid-skilled clinical care staff such as nurses and midwives, or non-patient facing staff who manage health facilities. This study estimated the job preferences of public health sector community health extension workers (HEWs), care providers including nurses and midwives, and non-patient-facing administrative and managerial staff in Ethiopia. We used a discrete choice experiment to estimate which aspects of a job are most influential to health worker choices. A multinomial logistic regression model estimated the importance of six attributes to respondents: salary, training, workload, facility quality, management and opportunities to improve patient outcomes. We found that non-financial factors were important to respondents from all three cadres: e.g., supportive management [odds ratio (OR) = 2.96, P-value = 0.001] was the only attribute that influenced the job choices of non-patient-facing administrative and managerial staff. Training opportunities (OR = 3.45, P-value < 0.001), supportive management (OR = 3.26, P-value < 0.001) and good facility quality (OR = 2.42, P-value < 0.001) were valued the most amongst HEWs. Similarly, supportive management (OR = 3.22, P-value < 0.001), good facility quality (OR = 2.69, P-value < 0.001) and training opportunities (OR = 2.67, P-value < 0.001) influenced the job choices of care providers the most. Earning an average salary also influenced the jobs choices of HEWs (OR = 1.43, P-value = 0.02) and care providers (OR = 2.00, P-value < 0.001), which shows that a combination of financial and non-financial incentives should be considered to motivate health workers in Ethiopia.
吸引、培训和留住高质量的卫生工作者对于卫生系统的良好运行至关重要，了解卫生工作者在其角色中看重什么是很重要的。许多研究通过采访医生或医学生来了解卫生工作者的劳动力市场偏好，而对社区卫生工作者等低技能干部、护士和助产士等中等技能临床护理人员或不面向患者的管理卫生设施的人员的工作偏好研究甚少。本研究估计了埃塞俄比亚公共卫生部门社区卫生推广工作者（HEW）、护理人员包括护士和助产士以及不面向患者的管理和行政人员的工作偏好。我们使用离散选择实验来估计工作的哪些方面对卫生工作者的选择影响最大。多项逻辑回归模型估计了六个属性对受访者的重要性：工资、培训、工作量、设施质量、管理和改善患者结果的机会。我们发现，非财务因素对来自所有三个干部的受访者都很重要：例如，支持性管理[比值比（OR）=2.96，P 值=0.001]是唯一影响不面向患者的管理和行政人员工作选择的属性。培训机会（OR=3.45，P 值<0.001）、支持性管理（OR=3.26，P 值<0.001）和良好的设施质量（OR=2.42，P 值<0.001）是 HEW 最看重的。同样，支持性管理（OR=3.22，P 值<0.001）、良好的设施质量（OR=2.69，P 值<0.001）和培训机会（OR=2.67，P 值<0.001）对护理人员的工作选择影响最大。获得平均工资也影响 HEW（OR=1.43，P 值=0.02）和护理人员（OR=2.00，P 值<0.001）的工作选择，这表明应考虑将财务和非财务激励相结合，以激励埃塞俄比亚的卫生工作者。
