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

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Author Info

  • 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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Related research

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. J Hurley, 1990. "Simulated Effects of Incomes-based Policies on the Distribution of Physicians," Centre for Health Economics and Policy Analysis Working Paper Series 11, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  2. 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.
  3. 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, vol. 14(4), pages 703-32, October.
  4. Lockwood, Michael, 1998. "Contribution of Contingent Valuation and Other Stated Preference Methods to Evaluation of Environmental Policy," Australian Economic Papers, Wiley Blackwell, vol. 37(3), pages 292-311, September.
  5. Franco, Lynne Miller & Bennett, Sara & Kanfer, Ruth, 2002. "Health sector reform and public sector health worker motivation: a conceptual framework," Social Science & Medicine, Elsevier, vol. 54(8), pages 1255-1266, April.
  6. 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, vol. 55(4), pages 765-99, July.
  7. 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.
  8. 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, vol. 23(6), pages 1285-1311, November.
  9. Kristiansen, Ivar Sønbø & Førde, Olav Helge, 1992. "Medical specialists' choice of location: The role of geographical attachment in Norway," Social Science & Medicine, Elsevier, vol. 34(1), pages 57-62, January.
  10. 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.
  11. 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.
  12. Kreps, David M, 1997. "Intrinsic Motivation and Extrinsic Incentives," American Economic Review, American Economic Association, vol. 87(2), pages 359-64, May.
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Citations

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Cited by:
  1. Tomas Lievens & Pieter Serneels, 2008. "Institutions for Health Care Delivery A Formal Exploration of what Matters to Health Workers Evidence from Rwanda," Economics Series Working Papers WPS/2008-29, University of Oxford, Department of Economics.
  2. Michael Clemens, 2009. "Skill Flow: A Fundamental Reconsideration of Skilled-Worker Mobility and Development," Working Papers 180, Center for Global Development.
  3. Pieter Serneels, 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," Economics Series Working Papers CSAE WPS/2010-10, University of Oxford, Department of Economics.
  4. Danila Serra & Pieter Serneels & Abigail Barr, 2010. "Intrinsic motivations and the non-profit health sector: Evidence from Ethiopia," CSAE Working Paper Series 2010-04, Centre for the Study of African Economies, University of Oxford.
  5. 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.
  6. Fagernäs, Sonja & Pelkonen, Panu, 2012. "Preferences and Skills of Indian Public Sector Teachers," IZA Discussion Papers 6563, Institute for the Study of Labor (IZA).
  7. 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.
  8. Dur, Robert & Zoutenbier, Robin, 2012. "Working for a Good Cause," IZA Discussion Papers 7058, Institute for the Study of Labor (IZA).
  9. 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.
  10. 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.
  11. Robert Dur & Robin Zoutenbier, 2011. "Working for a Good Cause," Tinbergen Institute Discussion Papers 11-168/1, Tinbergen Institute, revised 23 Apr 2013.
  12. 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.

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