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

Abstract Background The current policy thrust in Nigeria is to ensure that there exists qualified, skilled, and adequate health workforce for the achievement of universal health coverage. To achieve this, evidence combination of strategies/interventions on factors influencing attraction, retention, and motivation of the health workforce is needed to ensure the equitable distribution of the health workforce across the country.Methods We conducted a discrete choice experiment study to determine the combinations of incentives that may increase the retention of frontline health workers in rural and remote areas in Nigeria. The study was undertaken across rural and urban locations in Bauchi State between August and October 2018 amongst 145 students and practicing health workers. Results Health workers are 14.6 and 14.4 times more likely to take up a rural posting or continue to stay in their present rural posts if there was basic housing and improvement of the quality of the facilities respectively. The preference for rural job location increased by 6.17 times if good schools for children's education were provided. The highest willingness-to-pay was for the provision of basic housing or housing allowance with a high utility of 0.609 followed by improved quality of facility with sufficient staff number and type, equipment, drugs, and medical supplies with a utility value of 0.607. Conclusion Improving the working conditions of health workers will support retention in rural health posts. Based on the findings, we recommend the introduction of housing incentives in rural and remote areas to support the retention of health workers. This should be accompanied by deliberate interventions to improve the quality of the health facilities ensuring adequate and functional equipment and uninterrupted supplies.