Cost-effectiveness analysis of human resources policy interventions to address the shortage of nurses in rural South Africa

Recent policy recommendations have called for increased research efforts to inform the design of cost-effective interventions to address the shortage of health workers in rural areas. This paper takes forward the recent use of Discrete Choice Experiments to assess the effects of potential incentives to attract nurses to rural areas. The analysis relies on data collected in South Africa between August and November 2008. Effectiveness measures derived from Discrete Choice Experiments are combined in a Markov model to derive the long-term effects of policies, and costs are evaluated with secondary data. Measures involving the selection of more nursing students who are more likely to accept positions in rural areas are shown to be the most cost-effective interventions. If such policies could not be implemented, the next best options are to offer preferential access to specialist training to nurses willing to work in rural areas.

► This is the first cost-effectiveness analysis of human resources interventions to attract staff to under-served areas in South Africa.
► In the absence of actual effect measures, the model builds upon the outputs of discrete choice experiments.
► The results show that rural allowances for nurses are not cost-effective interventions.
► Recruiting more nurses from rural origins or giving better access to education to rural nurses would be cost-effective.