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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

Author

Listed:
  • Serneels, Pieter

    () (University of East Anglia)

  • Montalvo, Jose G.

    () (Universitat Pompeu Fabra)

  • Pettersson, Gunilla

    () (University of Essex)

  • Lievens, Tomas

    () (Oxford Policy Management)

  • Butera, Jean Damascene

    (Abt Associates, Inc.)

  • Kidanu, Aklilu

    (Miz-Hasab Research Center)

Abstract

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. 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. We find that 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. These 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

  • Serneels, Pieter & Montalvo, Jose G. & Pettersson, Gunilla & Lievens, Tomas & Butera, Jean Damascene & Kidanu, Aklilu, 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," IZA Discussion Papers 4831, Institute for the Study of Labor (IZA).
  • Handle: RePEc:iza:izadps:dp4831
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    References listed on IDEAS

    as
    1. 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.
    2. 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.
    3. Patrick Francois & Michael Vlassopoulos, 2008. "Pro-social Motivation and the Delivery of Social Services," CESifo Economic Studies, CESifo, vol. 54(1), pages 22-54, March.
    4. 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.
    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 464-498, November.
    6. 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.
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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. 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. 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.
    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, 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. 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.
    7. Fagernäs, Sonja & Pelkonen, Panu, 2017. "Where's the Teacher? How Teacher Workplace Segregation Impedes Teacher Allocation in India," IZA Discussion Papers 10595, Institute for the Study of Labor (IZA).

    More about this item

    Keywords

    labour supply; health workers; health care delivery; public service;

    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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