How to attract health workers to rural areas  in low- and middle-income countries: findings from discrete choice experiments

One of the biggest challenges for policy makers in the health sector in both developed and developing countries is attracting health workers to rural areas. Globally, approximately one-half of the population lives in rural areas, but these areas are served by only 38 per cent of the total nursing workforce and by less 25 per cent of the total physician workforce. This lack of qualified health workers in rural areas is a significant barrier to service delivery, impeding access to healthcare services for a significant percentage of the population. In low- and middle-income countries such shortages slow progress towards attaining the Sustainable Development Goals and challenge the aspiration of achieving health for all. This project, carried out in collaboration with a number of external bodies (World Bank; World Health Organization; Health Economics Unit, University of Cape Town; National Centre for Global Health and Medicine, Japan) explored the use of discrete choice experiments to better understand health worker preferences in low- and middle-income countries. DCEs have been conducted in Liberia, Vietnam, India and Senegal.

Outcome and Translation

This work provides guidance to policy makers on optimal contracts to induce health workers to live in remote and rural areas. We have also produced a ‘User Guide on How to Conduct a Discrete Choice Experiment for Health Workforce Recruitment and Retention in Remote and Rural Areas’ ( This should be useful for those considering using a DCE to address issues around health worker recruitment and retention.

HERU researchers involved in this research project: Mandy Ryan and Nicolas Krucien

External collaborators: A Amaeda (World Bank); M Alfano (University College London); A Honda (University of Cape Town); M Nagai, N Fujita (National Centre for Global Health and Medicine, Japan).


Rao, K., Ramani, S., Murthy, S., Hazarik, I., Khandpur, N., Choskshi, M., Khanna, S., Vujicic, M., Berman, P. and Ryan, M. (2010) Health worker attitudes towards rural services in India: results from qualitative research. Health, nutrition and population discussion paper, HNP, World Bank.

Vujicic, M., Alfano, M., Ryan, M., Sanford Wesseh, C. and Brown-Annan, J. (2010) Policy options to attract nurses to rural Liberia. Evidence from a discrete choice experiment, Health, Nutrition and Population Discussion Paper, World Bank

Rao, K., Shroff, Z., Ramani, S., Khandpur, N., Murthy, S., Hazarika, I., Choksi, M., Ryan, M., Berman, P. and Vijuvic, M. (2012) How to attract health workers to rural areas. Findings from a discrete choice experiment from India, World Bank.

Ryan, M., Kolstad, J., Rockers, P. and Dolea, C. (2012) How to conduct a discrete choice experiment for health workforce recruitment and retention in remote and rural areas: a user guide with case studies, Geneva:World Health Organization and World Bank.

Ramani, S., Rao, K. D., Ryan, M., Vujicic, M. and Berman, P. (2013) 'For more than love or money: attitudes of student and in-service health workers towards rural service in India', Human Resources for Health, 11(1), 58.

Rao, K. D., Ryan, M., Shroff, Z., Vujicic, M., Ramani, S. and Berman, P. (2013) 'Rural clinician scarcity and job preferences of doctors and nurses in India: a discrete choice experiment', PLoS One, 8(12), e82984.

Honda, A., Krucien, N., Ryan, M., Diouf, I.S.N., Salla, M., Nagai, M. and Fujita, N. (2019) 'For more than money: willingness of health professionals to stay in remote Senegal', Human Resources for Health, 17(1), 28.


Alfano, M., Vujicic, M. and Ryan, M. (2011) 'Formulating effective policies for health worker recruitment to rural areas: a joint estimation of preferences, costs, motivation and attitudes', International Health Economic Association Conference, Toronto, July 2011.

Ryan, M. (2011) 'Policy options to attract health workers to rural Liberia: evidence from a discrete choice experiment', Yunus Centre for Social Business and Health, Glasgow Caledonian University, November 2011.

Vujicic, M., Ryan, M. and Alfano, M. (2011) 'Estimating conditional and unconditional demand using discrete choice experiments: an application to nurse location decisions in Liberia', International Choice Modelling Conference, Institute of Transport Studies, University of Leeds, July 2011.

Rao, K., Shroff, Z., Ramani, S., Khandpur, N., Murthy, S., Hazarika, I., Choski, Ryan, M., Berman, P. and Vijuvic, M. (2012) 'How to attract health workers to rural areas? Findings from a discrete choice experiment from India', Bringing Evidence into Public Health Policy (EPHP) Conference., Bangladore, India, October 2012.

Ryan, M. (2012) 'Using discrete choice experiments to inform health services research: an application to health worker choices in rural Liberia', Centre for Clinical Epidemiology and Evaluation, University British Columbia, Vancouver, Canada, March 2012.

Honda, A., Krucien, N. and Ryan, M. (2017) 'What makes you happy? The role of intrinsic motivation on health workers’ decisions to stay in rural areas', 5th International Choice Modelling Conference, Cape Town, South Africa, 3-5 April 2017.