Employment preferences of healthcare workers in South Africa: Findings from a discrete choice experiment

PLoS One. 2021 Apr 28;16(4):e0250652. doi: 10.1371/journal.pone.0250652. eCollection 2021.

Abstract

There is a maldistribution of human resources for health globally, with many Lower- and Middle-Income Countries experiencing significant shortages. We examined healthcare workers' job preferences in South Africa to identify factors which potentially influence employment decisions. A discrete choice experiment was conducted among 855 South African healthcare workers critical to its national HIV testing and treatment programs. Job characteristics included workload, workplace culture, availability of equipment, training opportunities, sector and facility type, location, salary and benefits. Main effects analysis was conducted using fixed effects logistic regression. Interaction effects identified divergence in preferences. Heavy workload (OR = 0.78; 95% C.I. 0.74-0.83), poor workplace culture (odds ratio 0.66; 95% C.I. 0.62-0.69), insufficient availability of equipment (OR = 0.67; 95% C.I. 0.63-0.70) and infrequent training opportunities (OR = 0.75; 95% C.I. 0.71-0.80) had large, significant effects on worker preferences. An increase in salary of 20% (OR = 1.29; 95% C.I. 1.16-1.44) had a positive effect on preferences, while a salary decrease of 20% (OR = 0.55; 95% C.I. 0.49-0.60) had a strong negative effect. Benefits packages had large positive effects on preferences: respondents were twice as likely to choose a job that included medical aid, pension and housing contributions worth 40% of salary (OR = 2.06; 95% C.I. 1.87-2.26), holding all else constant. Although salary was important across all cadres, benefits packages had larger effects on job preferences than equivalent salary increases. Improving working conditions is critical to attracting and retaining appropriate health cadres responsible for the country's HIV services, especially in the public sector and underserved, often rural, communities. Crucially, our evidence suggests that factors amenable to improvement such as workplace conditions and remuneration packages have a greater influence on healthcare workers employment decisions than employment sector or location.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Career Choice*
  • Female
  • Health Personnel / psychology*
  • Humans
  • Logistic Models
  • Male
  • Odds Ratio
  • Public Sector
  • Salaries and Fringe Benefits
  • South Africa
  • Surveys and Questionnaires
  • Workload
  • Workplace

Grants and funding

The work described in this manuscript was completed under the USAID Human Resources for Health in 2030 (HRH2030) program, which was funded through PEPFAR (Cooperative Agreement Number AID-OAA-A-15-00046). The work was completed under Sub-agreement number HRH2030SA-2017-001 between Chemonics International Inc. and Foundation for Professional Development (Ltd) Pty. Award recipient author initials - AMM Funder websites: https://hrh2030program.org/; https://www.hiv.gov/federal-response/pepfar-global-aids/pepfar. The funders (i.e., USAID and Chemonics International Inc.) requested that a DCE methodology be included in the study design. The funders did not have a role in the development of data collection tools, data collection or data analysis. The funders reviewed the original manuscript and provided approval to submit for publication. The funder’s involvement does not alter our adherence to PLOS ONE policies on sharing data and materials. Since 1 April 2020, AE Mumbauer has been employed by Qode Health Solutions, a commercial company. AE Mumbauer was employed by the Foundation for Professional Development for the duration of the study period described in this manuscript, and during the initial drafting of this manuscript. Qode Health Solutions did not play any role in the study described in this manuscript.