Incentives Attracting Graduating Health Science College Students to Rural Health Postings in Southwestern Ethiopia: A Discrete Choice Experiment

Introduction : The health workforce is the backbone of health systems and essential for achieving universal health coverage. However, Ethiopia faces a shortage of health workers and an uneven distribution between urban and remote areas. This study aims to identify the job preferences of graduating health science college students, with the goal of attracting them to remote areas. Methods : Relevant attributes were identified through literature review, focus group discussions, and interviews with college students, health workers, and health-systems managers. Based on eight attributes (e.g., salary, education, housing, location, timely payment, medicine and equipment, management culture, and infrastructure) we designed a discrete choice experiment that was administered to 332 graduating class students at Arbaminch Health Science College. We used a mixed logit model to estimate the utility of each job attribute. We calculated the relative importance college students placed on the attributes. We also calculated willingness to pay for each job attribute. Results : Health science students at Arbaminch Health Science College preferred higher salaries, but education upgrading opportunity was the most important attribute. There was a strong preference for opportunities to further education after one year of service (β = 1.17), two years (β = 0.99), or three years (β = 0.86) compared to no education. Advanced housing (β = 0.26, 95% CI= 0.12, 0.40) and basic housing (β = 0.11, 95% CI= -0.02, 0.25) were preferred compared to no housing. Students also preferred supportive management, timely payment, and the availability of medicine and equipment. The relative importance estimates suggests that education was the important attribute, followed by salary, housing, and timely payment. Students were willing to accept salary reductions of 8869 ETB ($164) for education opportunities and 1988 ETB ($37) for advanced housing. Conclusion : This study utilized college student, health worker, and health system manager perspectives to identify realistic incentives to attract health science college students to remote areas of southwestern Ethiopia. Non-monetary incentives (e.g., education opportunities and housing) and monetary incentives (e.g., improved salary) are crucial motivators for health science college students and should be considered as part of incentive package to attract them to remote areas of southwestern Ethiopia.