Diversity in career preferences of future health workers in Rwanda : where, why, and for how much?

Human resources for health are a priority to improve health outcomes in Africa. In order to strengthen policies based on evidence, a better understanding is needed of health worker choice and behaviour. This book tries to help fill that gap. Relying on unique survey data, it analyses the career preferences of future health workers in Rwanda, focusing on their sector preference, their willingness to work in a rural area, likelihood to migrate abroad, and readiness to work in a high HIV prevalence environment. The findings show that health workers are not as uniform as is often thought, and can have very different preferences. Their reservation wages for different job types cover a wide range, and there are substantial differences in intrinsic motivation and attitudes to risk. But there are also communalities among these future health workers. While the public sector remains the biggest employer in Rwanda it is not the most popular one; and the vast majority is happy to start their career in a rural setting. The results also show the importance of intrinsic motivation, which is associated with a number of career preferences and expectations like the preference for rural service, expectations about income and the preference for dual practice. Governments in Africa have identified human resources for health as a policy priority. To improve policies, this book provides evidence on health workers’ choice and behaviour. Why, where and for how much will be a valuable resource for government officials in Rwanda and beyond to design effective human resource policies.

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.

Relying on unique survey data, this paper analyzes the career preferences of future health workers in Rwanda, focusing on their sector preferences, their willingness to work in rural areas, their likelihood to migrate abroad, and their readiness to work in a high HIV prevalence environment. The findings show that health workers are not as uniform as is often thought, and can have very different preferences regarding wages, intrinsic motivation, and attitudes toward risk. But there are commonalities among future health workers, and the results highlight the importance of intrinsic motivation. To improve health policies, many governments have identified human resources in the health field as a policy priority. To improve policies, this paper provides evidence on health workers’ choices and behavior, and it will be a valuable resource for government officials to design effective human resource policies. This working paper was produced as part of the World Bank’s Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom, and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition, and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharmaceuticals, Governance and Service Delivery, and Infrastructure and ICT.