Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.
Centre for Decision Research, Management Division, Leeds University Business School, UK.
Soc Sci Med. 2022 Aug;307:115151. doi: 10.1016/j.socscimed.2022.115151. Epub 2022 Jun 20.
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.
了解卫生工作者的工作偏好有助于政策制定者更好地调整激励措施，以留住公共部门有积极性的劳动力。然而，在陈述偏好选择模型中，卫生工作者的工作动机并没有被纳入，也许令人惊讶的是，作为卫生工作者工作选择的一个重要前提。本文首次应用混合选择模型来衡量社区卫生工作者（CHWs）的工作偏好差异在多大程度上可以用多维激励来解释。我们在 2019 年对埃塞俄比亚的 202 名 CHWs 进行了访谈。使用一系列 30 个问题，采用五点李克特量表对动机进行了定量评估。使用未标记的离散选择实验来捕捉对假设工作的陈述偏好。我们估计了三个模型，并探讨了哪个模型最适合选择数据。我们发现，混合选择模型比简单的选择模型更适合，并且为 CHWs 的偏好提供了额外的行为洞察力。内在动机强的 CHWs 对高于平均水平的工资有很强的负效用，但更喜欢良好的设施质量和良好的健康结果。相反，被评估为外在动机的 CHWs 对工作量大的工作有负效用，并且更喜欢高于平均水平的工资。我们展示了 CHWs 工作偏好的异质性与其动机之间的联系，表明政策制定者和管理者了解这种联系很重要，以便让卫生工作者为获得正确的激励而付出更多努力，并从长远来看留住有积极性的劳动力。
