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Factors influencing attraction and retention of frontline health workers in remote and rural areas in Nigeria: a discrete choice experiment


The policy thrust in Nigeria is to ensure qualified, skilled, and adequate health workforce to achieve universal health coverage. We designed a discrete choice experiment to determine the combinations of incentives that may increase the attraction and retention of frontline health workers. We conducted the study in Bauchi State amongst 145 students and health workers. Health workers are 14.6 and 14.4 times more likely to take up a rural posting or continue to stay in their present rural posts if there was basic housing and improvement of the quality of the facilities respectively. The preference for rural job location increased 6.17 times when good schools for children's education were provided. Ensuring availability of basic housing, improving the quality of health facilities, and ensuring good schools for children’s educations are essential factors that may support attraction and retention of health workers. These strategies will support health care services in rural areas and achieving universal health coverage.

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The authors wish to express their profound gratitude to the respondents in Bauchi State.


Funding support was provided by the Government of Canada through Global Affairs Canada through the Enhancing the Ability of Frontline Health Workers to Improve Health in Nigeria Project –A-035024/1.

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Authors and Affiliations



All authors meet the ICMJE authorship criteria—SCO and MKO conceived the study. SCO designed the protocol. SCO and CN designed the tools and conducted data collection and analysis. SCO and CN drafted the initial manuscript. SCO, CN and MKO reviewed and approved the final manuscript.

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Correspondence to Sunny C. Okoroafor.

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The authors declare no conflict of interest.

Ethical approval

Research ethical clearance for this study was obtained from the National Health Research Ethics Committee (NHREC Approval Number NHREC/01/01/2007–12/07/2018) of the Federal Ministry of Health and approval for data collection was obtained from the Bauchi State Ministry of Health.

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Okoroafor, S.C., Osubor, M.K. & Nwachukwu, C. Factors influencing attraction and retention of frontline health workers in remote and rural areas in Nigeria: a discrete choice experiment. J Public Health Pol (2022).

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  • Community health workers
  • Discrete choice experiment (DCE)
  • Nigeria
  • Rural and remote areas
  • Attraction and retention strategies