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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
  • Jose G. Montalvo
  • Gunilla Pettersson
  • Tomas Lievens
  • Jean Damascene Butera
  • Aklilu Kidanu

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 attached 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 significantly 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 a rural area, and that faith-based institutions matter.

Suggested Citation

  • 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.
  • Handle: RePEc:csa:wpaper:2010-10
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    References listed on IDEAS

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    1. Lindelow, Magnus & Serneels, Pieter, 2006. "The performance of health workers in Ethiopia: Results from qualitative research," Social Science & Medicine, Elsevier, vol. 62(9), pages 2225-2235, May.
    2. Timothy Besley & Maitreesh Ghatak, 2005. "Competition and Incentives with Motivated Agents," American Economic Review, American Economic Association, vol. 95(3), pages 616-636, June.
    3. Avinash Dixit, 2002. "# Incentives and Organizations in the Public Sector: An Interpretative Review," Journal of Human Resources, University of Wisconsin Press, vol. 37(4), pages 696-727.
    4. Lindelow, Magnus & Serneels, Pieter, 2006. "The performance of health workers in Ethiopia: Results from qualitative research," Social Science & Medicine, Elsevier, vol. 62(9), pages 2225-2235, May.
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    Cited by:

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    2. 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.
    3. Ernestina Coast & Nicola Jones & Umutoni Marie Francoise & Workneh Yadete & Roberte Isimbi & Kiya Gezahegne & Letisha Lunin, 2019. "Adolescent Sexual and Reproductive Health in Ethiopia and Rwanda: A Qualitative Exploration of the Role of Social Norms," SAGE Open, , vol. 9(1), pages 21582440198, March.
    4. Timothy Besley & Maitreesh Ghatak, 2005. "Competition and Incentives with Motivated Agents," American Economic Review, American Economic Association, vol. 95(3), pages 616-636, June.
    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. Wilbroad Mutale & Peter Godfrey-Fausset & Margaret Tembo Mwanamwenge & Nkatya Kasese & Namwinga Chintu & Dina Balabanova & Neil Spicer & Helen Ayles, 2013. "Measuring Health System Strengthening: Application of the Balanced Scorecard Approach to Rank the Baseline Performance of Three Rural Districts in Zambia," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-11, March.
    7. Sonja Fagernäs & Panu Pelkonen, 2012. "Preferences and skills of Indian public sector teachers," IZA Journal of Labor & Development, Springer;Forschungsinstitut zur Zukunft der Arbeit GmbH (IZA), vol. 1(1), pages 1-31, December.
    8. Cheick Sidya Sidibé & Ousmane Touré & Jacqueline E W Broerse & Marjolein Dieleman, 2019. "Rural pipeline and willingness to work in rural areas: Mixed method study on students in midwifery and obstetric nursing in Mali," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-13, September.
    9. Sonja Fagernäs & Panu Pelkonen, 2011. "Whether to Hire Local Contract Teachers? Trade-off Between Skills and Preferences in India," SERC Discussion Papers 0083, Centre for Economic Performance, LSE.
    10. Fagernäs, Sonja & Pelkonen, Panu, 2017. "Where's the Teacher? How Teacher Workplace Segregation Impedes Teacher Allocation in India," IZA Discussion Papers 10595, Institute of Labor Economics (IZA).
    11. Reneé Pereyra-Elías & Percy Mayta-Tristán & Juan José Montenegro-Idrogo & Christian R Mejia & Gabriel Abudinén A. & Rita Azucas-Peralta & Jorge Barrezueta-Fernandez & Luis Cerna-Urrutia & Adrián DaSil, 2016. "Differences on Primary Care Labor Perceptions in Medical Students from 11 Latin American Countries," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-12, July.
    12. Berhanu Feysia & Christopher H. Herbst & Wuleta Lemma & Agnes Soucat, 2012. "The Health Workforce in Ethiopia : Addressing the Remaining Challenges," World Bank Publications - Books, The World Bank Group, number 2226.

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    More about this item

    JEL classification:

    • J22 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Time Allocation and Labor Supply
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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