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Who Wants to Work in a Rural Health Post? The Role of Intrinsic Motivation, Rural Background and Faith-Based Institutions in Rwanda and Ethiopia

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  • Pieter Serneels

Abstract

Background: Most developing countries face shortages of health workers in rural areas.� This has profound consequences for health service delivery, and ultimately for health outcomes.� To design policies that rectify these geographic imbalances it is vital to understand what factors determine health workers' choice to work in rural areas.� But empirical analysis of health worker preferences has remained limited due to the lack of data.Methods: Using unique contingent valuation data from a cohort survey of 412 nursing and medical students in Rwanda, this paper examines the determinants of future health workers' willingness to work in rural areas, as measured by rural reservation wages, using regression analysis.� These data are also combined with those from an identical survey in Ethiopia to enable a two-country analysis.Results: Health workers with higher intrinsic motivation - measured as the importance attatched to helping the poor - as well as those who have grown up in a rural area, and Adventists who participate in a local bonding scheme are all signfiicantly more willing to work in a rural area.� The main Rwanda result for intrinsic motivation is strikingly similar to that obtained for Ethiopia and Rwanda together.Discussion: The results suggest that in addition to economic incentives, intrinsic motivation and rural origin play an important role in health workers' decisions to work in rural area, and that faith-based institutions matter.

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Paper provided by University of Oxford, Department of Economics in its series Economics Series Working Papers with number CSAE WPS/2010-10.

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Date of creation: 01 May 2010
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Handle: RePEc:oxf:wpaper:csae-wps/2010-10

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  1. Peter A. Diamond & Jerry A. Hausman, 1994. "Contingent Valuation: Is Some Number Better than No Number?," Journal of Economic Perspectives, American Economic Association, vol. 8(4), pages 45-64, Fall.
  2. Serneels, Pieter & Lindelow, Magnus & Garcia-Montalvo, Jose & Barr, Abigail, 2005. "For public service or money : understanding geographical imbalances in the health workforce," Policy Research Working Paper Series 3686, The World Bank.
  3. Paul R. Portney, 1994. "The Contingent Valuation Debate: Why Economists Should Care," Journal of Economic Perspectives, American Economic Association, vol. 8(4), pages 3-17, Fall.
  4. Anderson, Malcolm & Rosenberg, Mark W., 1990. "Ontario's underserviced area program revisited: An indirect analysis," Social Science & Medicine, Elsevier, vol. 30(1), pages 35-44, January.
  5. Michael A. Shields, 2004. "Addressing nurse shortages: what can policy makers learn from the econometric evidence on nurse labour supply?," Economic Journal, Royal Economic Society, vol. 114(499), pages F464-F498, November.
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Cited by:
  1. Vujicic, Marko & Shengelia, Bakhuti & Alfano, Marco & Thu, Ha Bui, 2011. "Physician shortages in rural Vietnam: Using a labor market approach to inform policy," Social Science & Medicine, Elsevier, vol. 73(7), pages 970-977.
  2. Besley, Timothy J. & Ghatak, Maitreesh, 2004. "Competition and Incentives with Motivated Agents," CEPR Discussion Papers 4641, C.E.P.R. Discussion Papers.
  3. Fagernäs, Sonja & Pelkonen, Panu, 2012. "Preferences and Skills of Indian Public Sector Teachers," IZA Discussion Papers 6563, Institute for the Study of Labor (IZA).
  4. Berhanu Feysia & Christopher H. Herbst & Wuleta Lemma & Agnes Soucat, 2012. "The Health Workforce in Ethiopia : Addressing the Remaining Challenges," World Bank Publications, The World Bank, number 2226, August.
  5. Olivier, Jill & Wodon, Quentin, 2012. "Satisfaction with faith-inspired health care services in Africa: review and evidence from household surveys," MPRA Paper 45374, University Library of Munich, Germany.
  6. Sonja Fagernäs & Panu Pelkonen, 2011. "Whether to Hire Local Contract Teachers? Trade-off Between Skills and Preferences in India," SERC Discussion Papers 0083, Spatial Economics Research Centre, LSE.

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