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Health Policy and Planning Advance Access originally published online on April 26, 2007
Health Policy and Planning 2007 22(3):128-138; doi:10.1093/heapol/czm005
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2007; all rights reserved.

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

Pieter Serneels1,*, Magnus Lindelow1, Jose G Montalvo2 and Abigail Barr3

1The World Bank, Washington DC, USA.
2University of Pompeu Fabra, Barcelona, Spain.
3Centre for the Study of African Economies, University of Oxford, UK.

* Corresponding author. The World Bank, 1818 H Street, NW, Washington DC 20433, USA. E-mail: pserneels{at}worldbank.org

Geographical imbalances in the health workforce have been a consistent feature of nearly all health systems, and especially in developing countries. In this paper we investigate the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analysing data obtained from contingent valuation questions for final year students from three medical schools and eight nursing schools, we find that there is substantial heterogeneity in the willingness to serve in rural areas. Using both ordinary least squares and maximum likelihood regression analysis, we find that household consumption and the student's motivation to help the poor are the main determinants of willingness to work in a rural area. We carry out a simulation on how much it would cost to get a target proportion of health workers to take up a rural post.

Key Words: Health care delivery, health workers, labour supply, public service

Accepted for publication 7 December 2006.


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