Meeting Rural Health Needs In Poor Countries
August 17th, 2010
by
Chris Fleming
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The August issue of Health Affairs, titled “Lessons From Around The World,” looks at the health systems in the developed nations of Spain and Switzerland. It also looks at the challenges faced by poor nations through the lens of Ethiopia.
Researchers Kara Hanson and William Jack wanted to explore what would best motivate more doctors and nurses to work in rural areas of poor countries, where they are desparately needed. They presented doctors and nurses in Ethiopia with a series of hypothetical job combinations of wages, working conditions, housing benefits, and training opportunities.
For doctors, higher wages and quality housing incentives had the biggest impact on their willingness to practice in towns in rural areas. For nurses, improvements in the availability of medical equipment and supplies were the factors most likely to bring about a move to a rural village, say Hanson, a reader in health system economics in the Department of Global Health and Development at the London School of Hygiene and Tropical Medicine, and Jack, an associate professor of economics at Georgetown.
Choosing the right incentive package requires a consideration of both the effects of different packages on health workers’ choices and the cost of those packages, the authors say, and they warn that getting doctors to accept jobs in rural areas will be expensive. They also warn that getting doctors to accept rural positions is only part of the battle: “Getting them to perform when they are there—to show up for work, to exert effort on the job, and to abstain from taking under-the-table payments or pilfering drug supplies to sell on the outside market—is the second challenge confronting governments and the rural communities they serve.” Hanson and Jack suggest that conditioning the incentive packages described above on the actual delivery of services “could help achieve both goals at once: getting doctors to move, and getting them to work.”
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