Motivating healthcare workers (HCWs) to ensure service delivery during public health emergencies: Insights from a discrete choice experiment during the COVID-19 pandemic in Bangladesh

The disruption of health service delivery during public health emergencies, like Ebola and COVID-19, due to hesitancy among healthcare workers (HCWs) is well-documented. While previous studies have identified motivating factors for HCWs, accommodating all is often unfeasible due to resource limitations. Thus, identifying precise preferences is crucial from a policy standpoint. This study aims to discern HCWs' preferences regarding working conditions and fringe benefits to ensure continued service during emergencies. Additionally, we investigate potential variations in preferences among HCWs who served in dedicated COVID-19 units versus those who did not, considering differences in perceived and realized risks. Conducting a discrete choice experiment (CE) and in-person interviews with 370 HCWs from four tertiary-level hospitals in Bangladesh, our findings reveal HCWs prioritize improving working conditions over fringe benefits. Notably, those in dedicated COVID-19 units exhibit a divergent preference pattern, indicating significant influence of perceived and realized risks. These insights offer valuable guidance for policymakers to address HCWs hesitancy and ensure optimal service delivery during national health crises. •Little is known about HCW motivation to continue service during emergencies in developing countries.•This study used a discrete choice experiment (CE) and in-person interviews in Bangladeshi hospitals.•HCWs prioritize working conditions over fringe benefits, according to the CE results.•COVID-19 unit HCWs showed different preferences, especially for working conditions and fringe benefits.•The study informs policymakers on improving HCW service delivery during health crises.