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For public service or money : understanding geographical imbalances in the health workforce

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  • Serneels, Pieter
  • Lindelow, Magnus
  • Garcia-Montalvo, Jose
  • Barr, Abigail

Abstract

Geographical imbalances in the health workforce have been a consistent feature of nearly all health systems, especially in developing countries. The authors investigate the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analyzing data obtained from contingent valuation questions, they find that household consumption and the student's motivation to help the poor, which is their proxy for intrinsic motivation, are the main determinants of willingness to work in a rural area. The authors investigate who are willing to help the poor and find that women are significantly more likely to help than men. Other variables, including a rich set of psycho-social characteristics, are not significant. Finally, the authors carry out some simulations on how much it would cost to make the entire cohort of starting nurses and doctors choose to take up a rural post.

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Bibliographic Info

Paper provided by The World Bank in its series Policy Research Working Paper Series with number 3686.

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Date of creation: 01 Aug 2005
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Handle: RePEc:wbk:wbrwps:3686

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Keywords: Health Monitoring&Evaluation; Health Systems Development&Reform; Educational Sciences; Economic Theory&Research; Housing&Human Habitats;

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References

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  1. 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, Royal Economic Society, vol. 114(499), pages F464-F498, November.
  2. Stéphane Luchini & Christel Protière & Jean-Paul Moatti, 2003. "Eliciting several willingness to pay in a single contingent valuation survey: application to health care," Health Economics, John Wiley & Sons, Ltd., vol. 12(1), pages 51-64.
  3. Anderson, Malcolm & Rosenberg, Mark W., 1990. "Ontario's underserviced area program revisited: An indirect analysis," Social Science & Medicine, Elsevier, Elsevier, vol. 30(1), pages 35-44, January.
  4. Mataria, Awad & Donaldson, Cam & Luchini, Stephane & Moatti, Jean-Paul, 2004. "A stated preference approach to assessing health care-quality improvements in Palestine: from theoretical validity to policy implications," Journal of Health Economics, Elsevier, Elsevier, vol. 23(6), pages 1285-1311, November.
  5. J Hurley, 1990. "Simulated Effects of Incomes-based Policies on the Distribution of Physicians," Centre for Health Economics and Policy Analysis Working Paper Series, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada 11, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  6. Lockwood, Michael, 1998. "Contribution of Contingent Valuation and Other Stated Preference Methods to Evaluation of Environmental Policy," Australian Economic Papers, Wiley Blackwell, Wiley Blackwell, vol. 37(3), pages 292-311, September.
  7. Cam Donaldson & Phil Shackley & Mona Abdalla, 1997. "Using Willingness To Pay To Value Close Substitutes: Carrier Screening for Cystic Fibrosis Revisited," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 145-159.
  8. Kreps, David M, 1997. "Intrinsic Motivation and Extrinsic Incentives," American Economic Review, American Economic Association, American Economic Association, vol. 87(2), pages 359-64, May.
  9. Mroz, Thomas A, 1987. "The Sensitivity of an Empirical Model of Married Women's Hours of Work to Economic and Statistical Assumptions," Econometrica, Econometric Society, Econometric Society, vol. 55(4), pages 765-99, July.
  10. Bolduc, Denis & Fortin, Bernard & Fournier, Marc-Andre, 1996. "The Effect of Incentive Policies on the Practice Location of Doctors: A Multinomial Probit Analysis," Journal of Labor Economics, University of Chicago Press, University of Chicago Press, vol. 14(4), pages 703-32, October.
  11. Franco, Lynne Miller & Bennett, Sara & Kanfer, Ruth, 2002. "Health sector reform and public sector health worker motivation: a conceptual framework," Social Science & Medicine, Elsevier, Elsevier, vol. 54(8), pages 1255-1266, April.
  12. Chomitz, Kenneth M. & Setiadi, Gunawan & Azwar, Azrul & Ismail, Nusye & Widiyarti, 1998. "What do doctors want? developing incentives for doctors to serve in Indonesia's rural and remote areas," Policy Research Working Paper Series 1888, The World Bank.
  13. Kristiansen, Ivar Sønbø & Førde, Olav Helge, 1992. "Medical specialists' choice of location: The role of geographical attachment in Norway," Social Science & Medicine, Elsevier, Elsevier, vol. 34(1), pages 57-62, January.
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Citations

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Cited by:
  1. Pieter Serneels & Jose G. Montalvo & Gunilla Pettersson & Tomas Lievens & Jean Damascene Butera & Aklilu Kidanu, 2010. "Who Wants to Work in a Rural Health Post? The Role of Intrinsic Motivation, Rural Background and Faith-Based Institutions in Rwanda and Ethiopia," CSAE Working Paper Series 2010-10, Centre for the Study of African Economies, University of Oxford.
  2. Robert Dur & Robin Zoutenbier, 2011. "Working for a Good Cause," Tinbergen Institute Discussion Papers 11-168/1, Tinbergen Institute, revised 23 Apr 2013.
  3. Sonja Fagernäs & Panu Pelkonen, 2011. "Whether to Hire Local Contract Teachers? Trade-off Between Skills and Preferences in India," Working Paper Series 1811, Department of Economics, University of Sussex.
  4. Serra, Danila & Serneels, Pieter & Barr, Abigail, 2010. "Intrinsic Motivations and the Non-Profit Health Sector: Evidence from Ethiopia," IZA Discussion Papers 4746, Institute for the Study of Labor (IZA).
  5. Michael A. Clemens, 2009. "Skill Flow: A Fundamental Reconsideration of Skilled-Worker Mobility and Development," Human Development Research Papers (2009 to present), Human Development Report Office (HDRO), United Nations Development Programme (UNDP) HDRP-2009-08, Human Development Report Office (HDRO), United Nations Development Programme (UNDP), revised Apr 2009.
  6. Pieter Serneels & Tomas Lievens, 2008. "Institutions for Health Care Delivery: A Formal Exploration of What Matters to Health Workers Evidence from Rwanda," CSAE Working Paper Series 2008-29, Centre for the Study of African Economies, University of Oxford.
  7. Sonja Fagernäs & Panu Pelkonen, 2012. "Preferences and skills of Indian public sector teachers," IZA Journal of Labor & Development, Springer, Springer, vol. 1(1), pages 1-31, December.
  8. Danila Serra & Pieter Serneels & Magnus Lindelow & Jose G. Montalvo, 2010. "Discovering the Real World : Health Workers' Career Choices and Early Work Experience in Ethiopia," World Bank Publications, The World Bank, number 5936, August.
  9. 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.
  10. Christophe Lemiere & Christopher H. Herbst & Negda Jahanshahi & Ellen Smith & Agnes Soucat, 2011. "Reducing Geographical Imbalances of Health Workers in Sub-Saharan Africa : A Labor Market Perspective on What Works, What Does Not, and Why," World Bank Publications, The World Bank, number 5919, August.
  11. William Jack & Joose De Laat & Kara Hanson & Agnes Soucat, 2010. "Incentives and Dynamics in the Ethiopian Health Worker Labor Market," World Bank Publications, The World Bank, number 5951, August.

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