How does additional education affect willingness to work in rural remote areas?

The main objective of this paper is to evaluate the effect of offering educational opportunities as a strategy to recruit health workers to rural areas. Tanzania, like the rest of sub-Saharan Africa, has a very small and unequally distributed health workforce. It has been suggested that rural remote jobs can be made more attractive to health workers with basic clinical skills by offering them the opportunity to upgrade their skills after a certain period of service. A data set capturing stated job preferences among freshly educated Tanzanian health workers with basic and more advanced clinical education is applied in order to investigate how additional education as an incentive mechanism affects willingness to work in rural areas. In order to control for selection effects into the additional education scheme, the two cadres are matched on propensity scores. It turns out that those health workers with advanced clinical education would have been more likely to prefer a job in a rural remote area had they not received the advanced clinical education. This effect (the ATT) is significant and substantial with several different specifications. The result is robust with regards to omitted variables and goes a long way in suggesting that a policy aimed at recruiting health personnel with basic clinical education to rural remote areas by offering jobs that include possibilities of upgrading after a certain period of service may be a temporary measure only.Education; Propensity Score Matching; Human Resources for Health; Mobility

How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania

The geographical imbalance of the health workforce in Tanzania represents a serious problem when it comes to delivering crucial health services to a large share of the population. This study provides new quantitative information about how to make jobs in rural areas more attractive to newly educated clinical officers. A unique data set stemming from a discrete choice experiment with clinical officer finalists in Tanzania is applied. The results show that offering continuing education after a certain period of service is one of the most powerful recruitment instruments the authorities have available. Increased salaries and hardship allowances will also substantially increase recruitment in rural areas. Offers of decent housing and good infrastructure, including the provision of equipment, will increase recruitment to rural remote areas but not as much as higher wages and offers of education. Women are less responsive to pecuniary incentives and are more concerned with factors that directly allow them to do a good job, while those with parents living in a remote rural area are generally less responsive to the proposed policies. When the willingness to help other people is a strong motivating force, policies that improve the conditions for helping people appear particularly effective.Human resources for health; Discrete choice experiments; Tanzania

Pro-social preferences and self-selection into the public health sector: evidence from economic experiments

There is growing interest in the role of pro-social motivation in public service delivery. In general, economists no longer question whether people have social preferences, but ask how and when such preferences will influence their economic and social decisions. Apart from revealing that individuals on average share and cooperate even when such actions lower their own material pay-off, economic experiments have documented substantial individual heterogeneity in the strength and structure of social preferences. In this paper we study the extent to which these differences are related to career choices, by testing whether preferences vary systematically between Tanzanian health worker students who prefer to work in the private health sector and those who prefer to work in the public health sector. Despite its important policy implications, this issue has received hardly any attention to date. By combining data from a questionnaire and two economic experiments, we find that students who prefer to work in the public health sector have stronger pro-social preferences than those who prefer to work in the private sector. We also show that the extent to which these students care about others can be conditional and linked to inequality aversion. A systematic selfselection of pro-socially motivated health workers into the public sector suggests that it is a good idea to have two sectors providing health services: this can ensure efficient matching of individuals and sectors by allowing employers in the two sectors to use different payment mechanisms tailored to attract and promote good performance from different types of health workers.pro-social preferences; career choice; economic experiments; health workers

Mixed logit estimation of willingness to pay distributions: a comparison of models in preference and WTP space using data from a health-related choice experiment.

Different approaches to modelling the distribution of WTP are compared using stated preference data on Tanzanian Clinical Officers’ job choices and mixed logit models. The standard approach of specifying the distributions of the coefficients and deriving WTP as the ratio of two coefficients estimation in preference space) is compared to specifying the distributions for WTP directly at the estimation stage (estimation in WTP space). The models in preference space fit the data better than the corresponding models in WTP space although the difference between the best fitting models in the two estimation regimes is minimal. Moreover, the willingness to pay estimates derived from the preference space models turn out to be unrealistically high for many of the job attributes. The results suggest that sensitivity testing using a variety of model specifications, including estimation in WTP space, is recommended when using mixed logit models to estimate willingness to pay distributions.WTP space; Stated preference methods; Discrete choice; Mixed logit; Willingness to pay*

GPs' implicit prioritization through clinical choices – evidence from three national health services

Acknowledgments The authors are grateful for valuable comments and inputs from participants at a series of seminars and conferences as well as to our three anonymous referees.Peer reviewedPostprin

Employment Protection and Child Development

This paper exploits conditional random assignment of patients to general practitioners to calculate a leniency measure of paid sick leave certification. We link these data to information on the human capital development of the patients’ children. We find sizable negative effects of parental sick leave enrollment on the child’s human capital development. In addition, we show that the timing of parental enrollment in these programs matter. In terms of mechanisms, we find that sick leave makes parents more likely to exit the workforce, earn lower wages, and become increasingly dependent on the social safety net. The results highlight that the trade-off between social protection and work incentives extends well beyond the individual worker, and emphasizes another dimension of the home environment through which children’s human capital is shaped. In addition, it implies that the costs of traditional employment protection programs are larger than previously thought

The Impact of Paid Maternity Leave on Maternal Health

We examine the impact of the introduction of paid maternity leave in Norway in 1977 on maternal health in the medium and long term. Using administrative data combined with survey data on the health of women around age 40, we find the reform improved a range of maternal health outcomes, including BMI, blood pressure, pain, and mental health. The reform also increased health-promoting behaviors, such as exercise and not smoking. The effects were larger for first-time and low-resource mothers and women who would have taken little unpaid leave in the absence of the reform.publishedVersio

Can Female Doctors Cure the Gender STEMM Gap? Evidence From Exogenously-Assigned General Practitioners

We use exogenously-assigned general practitioners to study the effects of female role models on educational outcomes of girls. Girls who are exposed to female GPs are more likely to sort into male-dominated education programs in high school, most notably STEMM. These effects persist as females enter college and select majors. The effects are larger for high-ability girls with low educated mothers, suggesting that female role models improve intergenerational mobility and narrow the gifted gap. This demonstrates that role model effects in education need not involve individuals in the classroom, but can arise due to everyday interactions with medical professionals.acceptedVersio

Features of Marfan syndrome not listed in the Ghent nosology : the dark side of the disease

Introduction: The revised Ghent nosology presents the classical features of Marfan syndrome. However, behind its familiar face, Marfan syndrome hides less well-known features. Areas covered: The German Marfan Organization listed unusual symptoms and clinical experts reviewed the literature on clinical features of Marfan syndrome not listed in the Ghent nosology. Thereby we identified the following features: (1) bicuspid aortic valve, mitral valve prolapse, pulmonary valve prolapse, tricuspid valve prolapse, (2) heart failure and cardiomyopathy, (3) supraventricular arrhythmia, ventricular arrhythmia, and abnormal repolarization, (4) spontaneous coronary artery dissection, anomalous coronary arteries, and atherosclerotic coronary artery disease, tortuosity-, aneurysm-, and dissection of large and medium-sized arteries, (5) restrictive lung disease, parenchymal lung disease, and airway disorders, (6) obstructive- and central sleep apnea, (7) liver and kidney cysts, biliary tract disease, diaphragmatic hernia, and adiposity, (8) premature labor, and urinary incontinence, (9) myopathy, reduced bone mineral density, and craniofacial manifestations, (10) atrophic scars, (11) caries, and craniomandibular dysfunction, (12) headache from migraine and spontaneous cerebrospinal fluid leakage, (13) cognitive dysfunction, schizophrenia, depression, fatigue, and pain, (14) and activated fibrinolysis, thrombin, platelets, acquired von Willebrand disease, and platelet dysfunction. Expert commentary: Future research, nosologies, and guidelines may consider less well-known features of Marfan syndrome

Wrong schools or wrong students? The potential role of medical education in regional imbalances of the health workforce in the United Republic of Tanzania

<p>Abstract</p> <p>Background</p> <p>The United Republic of Tanzania, like many other countries in sub-Saharan Africa, faces a human resources crisis in its health sector, with a small and inequitably distributed health workforce. Rural areas and other poor regions are characterised by a high burden of disease compared to other regions of the country. At the same time, these areas are poorly supplied with human resources compared to urban areas, a reflection of the situation in the whole of Sub-Saharan Africa, where 1.3% of the world's health workforce shoulders 25% of the world's burden of disease. Medical schools select candidates for training and form these candidates' professional morale. It is therefore likely that medical schools can play an important role in the problem of geographical imbalance of doctors in the United Republic of Tanzania.</p> <p>Methods</p> <p>This paper reviews available research evidence that links medical students' characteristics with human resource imbalances and the contribution of medical schools in perpetuating an inequitable distribution of the health workforce.</p> <p>Existing literature on the determinants of the geographical imbalance of clinicians, with a special focus on the role of medical schools, is reviewed. In addition, structured questionnaires collecting data on demographics, rural experience, working preferences and motivational aspects were administered to 130 fifth-year medical students at the medical faculties of MUCHS (University of Dar es Salaam), HKMU (Dar es Salaam) and KCMC (Tumaini University, Moshi campus) in the United Republic of Tanzania. The 130 students represented 95.6% of the Tanzanian finalists in 2005. Finally, we apply probit regressions in STATA to analyse the cross-sectional data coming from the aforementioned survey.</p> <p>Results</p> <p>The lack of a primary interest in medicine among medical school entrants, biases in recruitment, the absence of rural related clinical curricula in medical schools, and a preference for specialisation not available in rural areas are among the main obstacles for building a motivated health workforce which can help correct the inequitable distribution of doctors in the United Republic of Tanzania.</p> <p>Conclusion</p> <p>This study suggests that there is a need to re-examine medical school admission policies and practices.</p