Getting Health Workers to Rural Areas : Innovative Analytic Work to Inform Policy Making

Decision makers face serious challenges in attracting health workers to rural areas, in both the developed and developing world, but while they have access to a wide range of policy options, the effectiveness of interventions is highly contingent on context. To make them more effective, decision makers need to have an in-depth understanding of, especially, the factors that influence individual workers decisions on choice of practice, particularly regarding relocation to rural areas. The current paper presents results of an empirical study conducted in Liberia and Vietnam using a discrete choice experiment (DCE). The study's aim was to predict the likelihood of health workers taking up a rural area job under alternative incentive schemes. This study is the first DCE analysis to then go the extra step of costing out the alternative packages. The analysis revealed quite different results for the two countries. The most powerful single incentive in motivating workers to practice in rural areas was increased pay in Liberia, and long-term education in Vietnam. The cost-effectiveness of incentives also varies by country. In Liberia, monetary incentives were by the most cost effective while in Vietnam it was opportunities for skills development. While the study methodology needs further enhancement, especially costing of incentive packages, the work shows that a DCE analysis can be a powerful tool in informing the design of rural area incentive schemes in developing countries