International Journal of Health Policy and Management

International Journal of Health Policy and Management

What Do Nurses Value Most? Evidence From a Discrete Choice Experiment in Indonesia’s Remote Regions

Articles in Press

Document Type : Original Article

Authors
Ferry Efendi 1, 2, 3, 4
Eka Mishbahatul Mar’ah Has 1
Rifky Octavia Pradipta 1, 3
Mei Chan Chong 5
Anna Kurniati 6
1 Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
2 School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
3 Research Center in Advancing Community Healthcare (REACH), Surabaya, Indonesia
4 Kaohsiung Medical University, Kaohsiung, Taiwan
5 Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
6 Ministry of Health, Jakarta, Indonesia
Abstract
Background
The uneven distribution of nurses across Indonesia’s remote regions remains a major obstacle to achieving universal health coverage and Sustainable Development Goals. Recruitment and retention policies for remote areas are often based on assumptions about what nurses value, while empirical evidence remains limited. This study aimed to examine the job attributes influencing nurses’ preferences for working in remote and very remote areas in Indonesia.

Methods
A discrete choice experiment (DCE) was conducted among 243 nurses with at least one year of experience in remote healthcare facilities in East Nusa Tenggara, Papua, and West Papua. Job attributes and levels were identified through literature reviews and focus group discussions (FGDs). Six attributes were included: work location, employment status, supporting facilities, basic living facilities, student financial aid, and monthly net income. Preferences were estimated using a conditional logit model, with willingness-to-accept (WTA) estimates supporting policy interpretation.

Results
Basic living facilities were the most influential factor in shaping nurses’ job preferences. Positions offering reliable access to clean water, electricity, and internet services were significantly more likely to be chosen than those without such facilities (odds ratio [OR] = 2.06; 95% CI: 1.82–2.33). Jobs in very remote areas were also preferred over rural postings (OR = 1.76; 95% CI: 1.52–2.04). In contrast, civil servant employment was less preferred than contractbased positions (OR = 0.56; 95% CI: 0.49–0.64), and direct provision of housing and transportation did not significantly influence job choice (OR = 1.07; 95% CI: 0.94–1.22). A higher monthly income increased the likelihood of selecting a remote posting.

Conclusion
Nurses’ preferences for remote postings in Indonesia are driven mainly by living conditions, employment security, and location, rather than financial incentives alone. Policies should prioritize basic infrastructure improvements and stable employment arrangements.
Keywords
Nurse Distribution
Access to Healthcare
Discrete Choice Experiment
Nurses
Health Workforce
Job Creation
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International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 23 June 2026

  • Received Date 13 October 2025
  • Revised Date 30 May 2026
  • Accepted Date 12 June 2026
  • First Published Date 23 June 2026
  • Published Date 23 June 2026