Intrinsic motivations and the non-profit health sector: Evidence from Ethiopia

Abstract

Economists have traditionally assumed that individual behavior is motivated exclusively by extrinsic incentives. Social psychologists, in contrast, stress that intrinsic motivations are also important. In recent work, economic theorists have started to build psychological factors, like intrinsic motivations, into their models. Besley and Ghatak (2005) propose that individuals are differently motivated in that they have different "missions," and their self-selection into sectors or organizations with matching missions enhances organizational efficiency. We test Besley and Ghatak's model using data from a unique cohort study. We generate two proxies for intrinsic motivations: a survey-based measure of the health professionals philanthropic motivations and an experimental measure of their pro-social motivations. We find that both proxies predict health professionals' decision to work in the non-profit sector. We also find that philanthropic health workers employed in the non-profit sector earn lower wages than their colleagues.

Pro-social preferences and self-selection into jobs: Evidence from South African nurses

“…In relation to labour supply decisions, some attention has been paid to the role of pro-social preferences to explain the self-selection of individuals into the public sector or into not-for-profit organisations, in particular in the delivery of social services (Besley and Ghatak, 2005;Delfgaauw, 2007;Francois and Vlassopoulos, 2008;Kolstad and Lindkvist, 2012;Serra et al, 2010). However, no attention has been given to the role of pro-social preferences in the decision to take up particular positions associated with low material welfare for the worker and high benefits for others, benefiting from the worker's presence.…”

Measuring the Performance of Health Workers

“…Besley and Ghatak (2005), for example, consider motivation as an individual's preference for a mission that is to be matched to the organization's mission. Emerging empirical evidence supports this view (Serra, Serneels, and Barr 2011).…”

Analyzing the Determinants of Health Worker Performance

“…Quantitative studies for Ethiopia and Rwanda find that a simple question measuring health worker willingness to help the poor is strongly correlated with willingness to work in rural areas, and this is interpreted as evidence for intrinsic motivation (Serra et al 2008;Serneels et al 2010). Comparing this survey measure with a measure for altruism obtained from an experimental game from a study on Rwanda provides evidence that both are significant predictors for preferring to work in the NGO sector (Serra, Serneels, and Barr 2011). Evidence for Thailand and South Africa also finds a strong relationship between motivation as measured by a game and willingness to work in a rural area .…”

“…A cohort study for Ethiopia indicates that dual practice is adopted at an early stage of career, with close to one-fifth of doctors having a secondary job in a private clinic three years out of college, with the primary motivation being to increase earnings (Serra, Serneels, and Barr 2011). The Rwanda qualitative study also finds that dual practice is structurally embedded in the system, because half of the medical students who expect to be working in the public sector five years after graduation expect to have an additional income from dual practice that is close to 50 percent of their base public sector salary (Lievens and Serneels 2006).…”