Skip to main content

Table 5 Cost per percentage point increase in rural job uptake

From: Assessment of interventions to attract and retain health workers in rural Zambia: a discrete choice experiment

  Total cost per working year (USD) Marginal cost per working year compared to base level (USD)1 Percentage of participants that would choose rural job Percentage point increase in rural uptake2 USD per percentage point increase3
Salary
Ref Base salary4 $7084    
1 Base salary + 20% rural allowance $ 8016 $932 46.2% 4.4 $214
2 Base salary + 25% rural allowance $8249 $1 165 50.4% 8.6 $136
3 Base salary + 30% rural allowance $8482 $1398 52.3% 10.5 $134
Housing
Ref Basic allowance offered (20% of base salary) $932    
4 Basic housing provided $1732 $800 44.5% 2.7 $297
5 Superior allowance offered (30% of base salary) $2732 $466 50.8% 9.0 $52
6 Superior housing provided $1398 $1800 78.4% 36.6 $49
Education
Ref Guaranteed paid leave after 2 years with no government financial assistance for study $9088    
7 Guaranteed paid leave after 3 years with eligibility for (not guaranteed) 75% government scholarship for study $8932 − $156 47.3% 5.5 − $28
8 Guaranteed paid leave after 4 years with 100% government scholarship for study guaranteed $9332 $244 58.8% 17.0 $14
Transport
Ref No access to ambulance or utility vehicle    
9 Reliable access to ambulance and utility vehicle (motorbike/vehicle) for official facility use only $4250 $4250 51.0% 9.2 $462
Medical equipment
Ref Standard list of medical equipment at health facility not always available    
10 Standard list of medical equipment at health facility always available $3167 $3167 44.1% 2.3 $1377
Attribute combinations5
 Highest levels of all (3, 6, 8, 9, 10) $7692 94.6% 52.8 $146
 Highest levels of all except salary (6, 8, 9, 10) $6294 92.0% 50.2 $125
 Superior housing (6) + full scholarship after 4 years (8) $2044 87.8% 46.0 $44
 Superior housing allowance (5) + full scholarship after 4 years (8) $710 67.2% 25.4 $28
  1. 1This table presents the marginal cost or difference in the cost of each higher-level job attribute compared to its reference, because this approach to costing aligns with the odds ratio and percentage uptake results, which compare to marginal benefit of each higher-level job attribute relative to uptake given the reference category. For example, in the case of salary, the reference attribute costs $7084 and salary plus a 20% rural allowance costs $8016, so the marginal cost of salary plus a 20% rural allowance is $932
  2. 2The percentage point increase in rural job uptake is based on a baseline rural uptake rate of 42.8% before the addition of any higher-level job attributes
  3. 3The cost (in USD) per percentage point increase provides a standardized way of looking at the cost benefit of each attribute. This value is the marginal cost of the job attribute compared to the reference divided by the marginal benefit in uptake of the attribute compared to the reference. For example, the marginal cost of salary plus a 20% rural allowance is $932, which is divided by 4.4 percentage points to get a cost per percentage point increase in uptake of $214
  4. 4The salary assumptions are based on the MOH policies for salary of a registered nurse as of 2017. Values would vary slightly for other cadres, but registered nurses were the focus of this analysis because they make up a large portion of the workforce and because of the government interest in retaining this cadre in particular in rural areas. The value is inclusive of standard benefits such as for housing and transport, as described in Additional file 2, but the 20% allowance is calculated using the base salary only, prior to allowances
  5. 5The numbers in this section refer to the job attributes as numbered in the top part of the table. Each attribute combination is compared to the reference category for all relevant job attributes