RESYST Working Paper 3: Pro-social preferences and self-selection into rural jobs: evidence from South African nurses

Lagarde M, Blaauw D , 2013
South Africa
London School of Hygiene and Tropical Medicine, UK; Centre for Health Policy, University of the Witwatersrand, South Africa

Governments frequently struggle to recruit and retain qualified staff to work in rural areas which often have more difficult working conditions, fewer educational opportunities and limited access to basic services. Although a growing body of work has investigated the role of pro-social preferences on the job choices of health workers, i.e. the extent to which factors such as altruism or concern for others, influence individuals' decisions, no attention has been given to their role in the decision to work in rural and isolated areas.

Using data from a longitudinal study of nurses in South Africa, the analysis in this paper tests the extent to which a measure of pro-social preferences, based on donations made by nurses in an economic experimental game during the baseline survey, predicts rural job choices three years later.

The research finds that the more dedicated the nurses – measured by their generosity towards patients in the dictator game – the more likely they are to have chosen a rural job. This finding is potentially meaningful for policy in South Africa. To ensure that a higher proportion of nurses are willing to choose rural posts, the recruitment processes of nursing students could try and ascertain the extent to which potential candidates show signs of dedication towards patients. Alternatively, assuming that professional dedication can be nurtured, health workers’ curricula and experience during their studies could be adapted to cultivate positive attitudes towards patients.

Working Paper | Health workforce