How to Conduct a Discrete Choice Experiment A …

1 How to Conduct a Discrete Choice Experiment for Health Workforce Recruitment and Retention in Remote and Rural Areas: A UsER GUiDE WitH case stUDiEsiWHO Library Cataloguing-in-Publication DataHow to Conduct a Discrete Choice Experiment for health workforce recruitment and retention in remote and rural areas: a user guide with case health services personnel. of health care. underserved areas. turnover. Health Organization. II. United States. Agency for International Development. 978 92 4 150480 5 (NLM classification: WA 390) World Health Organization 2012 All rights reserved. Publications of the World Health Organization are available on the WHO web site ( ) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.)

2 : +41 22 791 3264; fax: +41 22 791 4857; e-mail: Requests for permission to reproduce or translate WHO publications whether for sale or for non-commercial distribution should be addressed to WHO Press through the WHO web site ( ).The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.

3 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in FranceGraphic design : Atelier Rasmussen / CH 2012 iForewordAn acute shortage of qualified health workers in remote and rural regions is a serious and widespread problem that is affecting many countries across the globe, but it affects the low income developing countries especially severely.

4 In many developing countries, these shortages and distributional imbal-ances in health workforce present a major obstacle in the achievement of health-related Millennium Development Goals, and significantly hamper their progress toward Universal Health Coverage. Thus, finding effective and feasible policy solutions to this problem is a priority concern for many developing Discrete Choice Experiment (DCE) methodology described in this User Guide is a quantitative research method that can measure the strength of preference and trade-offs of the health workers toward different job characteristics that can influence their decision to take up rural postings. This User Guide offers step-by-step advice on the application of DCE in identifying policy interventions appropriate to that country context in addressing health workforce shortages in remote and rural areas.

5 The User Guide also includes two case studies from Tanzania and Uganda that demonstrate the application of this method in a real life context. It is intended to be used as part of a training program for the researchers involved in the design and implementation of DCE, but it could also be used as part of a broader training program on health services research and evaluation. This User Guide is a product of close collaboration among the three agencies The World Bank, World Health Organization and the USAID-funded CapacityPlus project and represents our shared commit-ment to supporting policy-relevant research on critical topics related to Human Resources for Health. It is our hope that this User Guide will contribute to a systematic analysis and a deeper understanding of the factors that inhibit recruitment and retention of qualified staff in remote and rural regions, and will help countries develop their own unique solutions to lifting this problem that are well-adapted to their country context.

6 (Jointly signed by)Nicole Klingman Wim Van LerbergheActing Director DirectorHealth, Nutrition and Population Department for Health Systems PoliciesThe World Bank and Workforce World Health OrganizationKate TulenkoDirector, CapacityPlusIntraHealth InternationaliiiiiiiiiiAcknowledgmentsTh is User Guide was prepared as a joint effort by the USAID-funded CapacityPlus, World Health Organization (WHO), and The World Bank. The primary authors are: Mandy Ryan, Health Economics Research Unit, University of Aberdeen and Consultant for the World Bank; Julie R. Kolstad, University of Bergen, Uni Rokkan Centre and Consultant for the World Bank; Peter C. Rockers, Harvard University and Consultant for CapacityPlus/IntraHealth International; and Carmen Dolea, World Health Organization.

7 The funding for this publication was provided by Norwegian Development Agency (NORAD), USAID through CapacityPlus, WHO, and the World Bank. The material presented in this User Guide is based on teaching material Professor Mandy Ryan and Dr Verity Watson have developed for their 3 day residential workshop, Using Discrete Choice Experiments in Health Economics: Theoretical and Practical issues . The staff at the National Institute for Medical Research (NIMR), Tanzania, provided valuable contribu-tion in developing and conducting the Discrete Choice Experiment in Tanzania. The Ministry of Health of Uganda also contributed significantly to the Conduct of Discrete Choice Experiment in Uganda which forms the basis for the Ugandan case study.

8 Julie R. Kolstad, Margaret Kruk, Lindsay Mangham, Nonglak Pagaiya, and Peter Rockers undertook short surveys on logistical issues facing those conducting Discrete Choice Experiments to address human resource issues in low and middle income following persons provided detailed comments and advice on the earlier drafts of this User Guide, and raised valuable issues during its preparation: Marco Alfano, Edson Ara jo, Peter Berman, Duane Blaauw, Jean-Marc Braichet, Arne Risa Hole, Ayako Honda, Wanda Jaskiewicz, Margaret Kruk, Manuel M. Dayrit, Akiko Maeda, Kamolnat Muangyim, Nonglak Pagaiya, Krishna Rao, Amani Siyam, Laura Stormont, Marko Vujicic and Verity Watson. Comments were also received from Christoph Kurowski, Magnus Lindelow, Christophe Lemiere, Christophe Herbst, Jishnu Das and Rajeev Ahuja.

9 The authors would like to thank all the participants at the meeting organized by WHO, the World Bank and CapacityPlus in October 2010: Tools for Implementing Rural Retention Strategies: Towards a How To Guide for Discrete Choice Experiments A Methods Workshop , who set the basis for developing this User 1 WHO, 2010. Tools for Implementing Rural Retention Strategies: Towards a How To Guide for Discrete Choice Experiments -A Methods Workshop . Meeting report. World Health Organization, October 2010, Geneva, Switzerland. Available online at: of ContentsForeword _____ 2 Acknowledgments _____ 3 Table of Contents _____ 4 Acronyms _____ 9 Introduction _____ 101. Step-by-step guide on how to Conduct DCEs in low- and middle-income settings __ Discrete Choice experiments: what are they and what can practitioners do with them?

10 _____ DCEs: an attribute-based measure of value _____ DCEs: a survey-based measure of value _____ Stages in conducting the DCE _____ Identification of attributes and assignment of levels _____ Selection of experimental design and construction of Choice sets _____ Development of the questionnaire, pretesting, and data collection _____ Data input _____ Data analysis and interpretation _____ Logistical issues in conducting DCEs _____ Why Conduct a DCE? _____ How long does it take? _____ How much does it cost? _____ What skills and competencies does the research team need? _____ What logistical challenges are likely? _____ How can policy makers use the results?