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

Objective To understand the factors influencing health workers' choice to work in rural areas as a basis for designing policies to redress geographic imbalances in health worker distribution. Methods A cohort survey of 412 nursing and medical students in Rwanda provided unique contingent valuation data. Using these data, we performed a regression analysis to examine the determinants of future health workers' willingness to work in rural areas as measured by rural reservation wages. These data were also combined with those from an identical survey in Ethiopia to enable a two-country analysis. Findings Health workers with higher intrinsic motivation - measured as the importance attached to helping the poor as well as those who had grown up in a rural area and Adventists who had participated in a local bonding scheme were all significantly more willing to work in a rural area. The main result for intrinsic motivation in Rwanda was strikingly similar to the result obtained for Ethiopia and Rwanda combined. Conclusion Intrinsic motivation and rural origin play an important role in health workers' decisions to work in a rural area, in addition to economic incentives, while faith-based institutions can also influence the decision.

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Discovering the Real World : Health Workers' Career Choices and Early Work Experience in Ethiopia
(World Bank, 2010-05-30) Serra, Danila; Serneels, Pieter; Lindelow, Magnus; Montalvo, Jose G.
The Ethiopian health sector faces a number of challenges related to human resources, including geographical imbalances in the distribution of health workers, problems with job satisfaction, and a high willingness to migrate abroad. To address these challenges with appropriate policies, more empirical evidence is needed. The Ethiopian Health Workers Cohort Study was set up to produce evidence as input to policy design. To generate insights on health workers' career choices, preferences, and job satisfaction, the study followed the same health workers over time. The first wave of the study was conducted in April 2004 and surveyed 219 nursing students and 90 medical students who were in their final year of study. In the second wave of the survey, which took place between May and September 2007, researchers re-interviewed the nurses and the doctors, who had now entered the labor market. This paper reports the descriptive findings of the second wave as well as changes that were identified between the two survey rounds. The report is structured as follows. This chapter provides an overview of the Ethiopian health sector and a brief description of the survey methodology. Chapter two presents data on the health professionals' current activities, including the distribution of job functions across locations, sectors, and facilities. Chapter three summarizes the findings on job characteristics such as salaries and nonmonetary benefits; it also provides information about health professionals' level of satisfaction with job and life of and its evolution over time. Chapter four reports the results regarding health workers' willingness to work in rural areas, including an analysis of the evolution of reservation wages for work in a rural area, obtained from responses to contingent valuation questions. Chapter five focuses on the health worker's likelihood of migrating abroad in the near future, again using specially designed questions. Each chapter after chapter two starts with a summary of the pertinent results.
The Role of Faith-Based Organizations in Maternal and Newborn Health Care in Africa
(2011) Widmer, M.; Betran, A. P.; Merialdi, M.; Requejo, J.; Karpf, T.
BACKGROUND: Global disparities in maternal and newborn health represent one of the starkest health inequities of our times. Faith-based organizations (FBOs) have historically played an important role in providing maternal/newborn health services in African countries. However, the contribution of FBOs in service delivery is insufficiently recognized and mapped. OBJECTIVES: A systematic review of the literature to assess available evidence on the role of FBOs in the area of maternal/newborn health care in Africa. SEARCH STRATEGY: MEDLINE and EMBASE were searched for articles published between 1989 and 2009 on maternal/newborn health and FBOs in Africa. RESULTS: Six articles met the criteria for inclusion. These articles provided information on 6 different African countries. Maternal/newborn health services provided by FBOs were similar to those offered by governments, but the quality of care received and the satisfaction were reported to be better. CONCLUSION: Efforts to document and analyze the contribution of FBOs in maternal/newborn health are necessary to increase the recognition of FBOs and to establish stronger partnerships with them in Africa as an untapped route to achieving Millennium Development Goals 4 and 5.
Diversity in Career Preferences of Future Health Workers in Rwanda : Where, Why, and for How Much?
(World Bank, 2010-03-01) Lievens, Tomas; Serneels, Pieter; Butera, Jean Damascene; Soucat, Agnes
The Government of Rwanda has identified human resources for health as one of its Policy priorities. This study aims to contribute to building a better understanding of health worker choice and behavior, and to improve evidence based policies. The work was undertaken by The Ministry of Health in a collaborative effort with the World Bank, building on the results of qualitative pre research, and is the first wave of a cohort survey with medical and nursing students. In comparison with other African countries, migration of health workers abroad may be less of a problem for Rwanda. The study finds that 80 percent of nursing and medical students report to have no intention to migrate abroad in the coming five years. Using a contingent valuation method to measure the reservation wage to migrate, we find that at the current public sector starting salary more than half the students will choose a job in Kigali instead of going abroad. But there is considerable heterogeneity in the willingness to work abroad. For example, students who are married or engaged are less likely to move abroad. Younger medical students require a higher average salary to stay in Rwanda compared to older students. Although Rwanda has a relatively low HIV prevalence compared to other African countries, there are problems with attitudes to HIV/AIDS, although the attitudes differ greatly between students, with medical students consistently more positive than nurses. Medical students score higher than nurses on medical knowledge related to HIV/AIDS, have higher levels of self reported knowledge on AIDS, and are also more familiar with HIV. Health students are generally averse to taking up work in high HIV prevalence areas but preferences vary widely, as is reflected in the wide span of reservation wages to accept a job in a high HIV prevalence area. Students are less willing to work in high HIV prevalence areas than to take up rural service.
Creating Incentives to Work in Ghana : Results from a Qualitative Health Worker Study
(World Bank, Washington, DC, 2011-11) Lievens, Tomas; Serneels, Pieter; Garabino, Sabine; Quartey, Peter; Appiah, Ebeneezer; Herbst, Christopher H.; Lemiere, Christophe; Soucat, Agnes; Rose, Laura; Saleh, Karima
The Ministry of Health, Ghana, is engaged in developing new Human Resources for Health (HRH) Strategy (2001-15); one that tries to draw on some of the evidence pertaining to the dynamics of the health labor market. This study is one of several efforts by the World Bank to support the Ministry of Health in its endeavor to develop a new evidence based HRH strategy. Using qualitative research (focus group discussions), this study carries out a microeconomic labor analysis of health worker career choice and of job behavior. The study shows how common problems related to distribution or performance of HRH are driven by the behavior of health workers themselves and are determined largely by select monetary and nonmonetary compensation. Such findings generate insights that provide a starting point for further analysis and a basis for the development of effective human resources for health policies.
Measuring the Contribution of Faith-Based Schools to Human Capital Wealth
(Taylor and Francis, 2019-11-25) Wodon, Quentin
This paper provides estimates of the contribution of faith-based schools to human capital wealth using recent World Bank data. Wealth is the assets base that enables nations to generate future income. Estimates suggest that human capital wealth accounts for two thirds of global wealth, a much larger proportion than natural capital and produced capital. This paper’s analysis relies on an assessment of the share of human capital wealth attributed to educational attainment, and the share of contribution of Catholic schools to educational attainment. The analysis suggests that Catholic schools contribute at least US$ 12 trillion to the changing wealth of nations.

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