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

22 Pages Posted: 22 Mar 2010

See all articles by Pieter M. Serneels

Pieter M. Serneels

University of Oxford - Centre for the Study of African Economies (CSAE)

José García Montalvo

Universitat Pompeu Fabra - Faculty of Economic and Business Sciences

Gunilla Pettersson Gelander

Birk Consulting

Tomas Lievens

Oxford Policy Management

Jean Damascène Butera

Abt Associates, Inc.

Aklilu Kidanu

affiliation not provided to SSRN

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.

Keywords: health care delivery, health workers, labour supply, public service

JEL Classification: J22, I11

Suggested Citation

Serneels, Pieter M. and García Montalvo, José and Pettersson Gelander, Gunilla and Lievens, Tomas and Butera, Jean Damascène and Kidanu, Aklilu, 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 Paper No. 4831. Available at SSRN: https://ssrn.com/abstract=1575884

Pieter M. Serneels (Contact Author)

University of Oxford - Centre for the Study of African Economies (CSAE) ( email )

Oxford OX1 3UL
United Kingdom

José García Montalvo

Universitat Pompeu Fabra - Faculty of Economic and Business Sciences ( email )

Ramon Trias Fargas 25-27
Barcelona, 08005
Spain

Gunilla Pettersson Gelander

Birk Consulting ( email )

Varberg
Sweden

Tomas Lievens

Oxford Policy Management ( email )

St. Aldates Courtyard
Oxford OX1 1BN
United Kingdom

Jean Damascène Butera

Abt Associates, Inc.

55 Wheeler Street
Cambridge, MA 02138-1168
United States

Aklilu Kidanu

affiliation not provided to SSRN

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