Employment preferences of public sector nurses in Malawi: results from a discrete choice experiment

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Abstract
To understand the employment preferences of Malawian public sector registered nurses, and to ascertain whether salary increases significantly affect how nurses regard their employment. A discrete choice experiment was used to assess the significance of six job attributes on nurses' preferences over pairs of job descriptions: net monthly pay, provision of government housing, opportunities to upgrade their qualifications, typical workload, availability of resources and place of work. A multivariate model was used to estimate the extent to which nurses were willing to trade between their monetary benefits, non-monetary benefits, and working conditions, and to determine the relative importance of the job attributes. Most nurses were willing to trade among attributes, and very few appeared to have preferences that were dominated by a single job attribute. All attributes had a statistically significant influence on nurses' preferences, and further analysis showed the rate at which they were willing to forego pay increases for other improvements in their employment conditions. Opportunities to upgrade professional qualifications, government housing and the increases in net monthly pay had the greatest impact on nurses' employment choices. Salary enhancement can improve the motivation and retention of nurses, as well as improvements of employment conditions, which support existing efforts to address the health worker shortage.