title: Motivation and incentive preferences of community health officers in Ghana: an economic behavioral experiment approach.
abstract: Health worker shortage in rural areas is one of the biggest problems of the health sector in Ghana and many developing countries. This may be due to fewer incentives and support systems available to attract and retain health workers at the rural level. This study explored the willingness of community health officers (CHOs) to accept and hold rural and community job postings in Ghana.
  
  
  
  A discrete choice experiment was used to estimate the motivation and incentive preferences of CHOs in Ghana. All CHOs working in three Health and Demographic Surveillance System sites in Ghana, 200 in total, were interviewed between December 2012 and January 2013. Respondents were asked to choose from choice sets of job preferences. Four mixed logit models were used for the estimation. The first model considered (a) only the main effect. The other models included interaction terms for (b) gender, (c) number of children under 5 in the household, and (d) years worked at the same community. Moreover, a choice probability simulation was performed.
  
  
  
  Mixed logit analyses of the data project a shorter time frame before study leave as the most important motivation for most CHOs (β 2.03; 95 % CI 1.69 to 2.36). This is also confirmed by the largest simulated choice probability (29.1 %). The interaction effect of the number of children was significant for education allowance for children (β 0.58; 95 % CI 0.24 to 0.93), salary increase (β 0.35; 95 % CI 0.03 to 0.67), and housing provision (β 0.16; 95 % CI -0.02 to 0.60). Male CHOs had a high affinity for early opportunity to go on study leave (β 0.78; 95 % CI -0.06 to 1.62). CHOs who had worked at the same place for a long time greatly valued salary increase (β 0.28; 95 % CI 0.09 to 0.47).
  
  
  
  To reduce health worker shortage in rural settings, policymakers could provide "needs-specific" motivational packages. They should include career development opportunities such as shorter period of work before study leave and financial policy in the form of salary increase to recruit and retain them.
authors.affiliation: Japan International Research Center for Agricultural Sciences, 1-1, Ohwashi, Tsukuba, Ibaraki, 305-8686, Japan.
authors.forename: Sakiko
authors.initials: S
authors.lastname: Shiratori
authors.affiliation: Japan International Cooperation Agency Health Section, 2nd Floor, The Elizabeth, No. 68A Senchi Link, Airport Residential Area, Accra, Ghana.
authors.forename: Enoch Oti
authors.initials: EO
authors.lastname: Agyekum
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shibanuma
authors.affiliation: Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East Region, Ghana.
authors.forename: Abraham
authors.initials: A
authors.lastname: Oduro
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Sumiyo
authors.initials: S
authors.lastname: Okawa
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo Region, Ghana.|Department of Epidemiology & Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Yeetey
authors.initials: Y
authors.lastname: Enuameh
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Yasuoka
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Kimiyo
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Dodowa Health Research Centre, P.O Box DD1, Dodowa, Accra, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Gyapong
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo Region, Ghana.
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.affiliation: Research and Development Division, Ghana Health Service, MB 190, Accra, Ghana.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ansah
authors.affiliation: Research and Development Division, Ghana Health Service, MB 190, Accra, Ghana.
authors.forename: Abraham
authors.initials: A
authors.lastname: Hodgson
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. mjimba@m.u-tokyo.ac.jp.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D004493:Education; D004651:Employment; D005190:Family; D005260:Female; D005869:Ghana; D006282:Health Personnel; D006798:Housing; D006801:Humans; D008297:Male; D009042:Motivation; D011634:Public Health; D012111:Residence Characteristics; D019035:Rural Health Services; D012424:Rural Population; D012456:Salaries and Fringe Benefits; D000078329:Workforce
keywords: Community health; Discrete choice experiment; Ghana; Health worker; Incentive; Job preference; Mixed logit; Motivation