Investigating the role of social preferences in health providers' decisions in South Africa.

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Public Health and Policy

Abstract

This MRC/ESRC post-doctoral fellowship will provide for the publication of a series of papers on the determinants of nurses‘ career choices in South Africa, and the expected effects of some policy interventions to attract them to rural posts. Quantitative in nature, these papers will address economic questions as well as policy-relevant ones. The results of this research will also be disseminated directly to policy-makers and the public through a combination of presentations at professional meetings and workshops, face-to-face meetings, distribution of policy briefs and posting on relevant websites. The research should ultimately contribute to improving health outcomes in medically underserved populations, by providing insight into the design of efficient policies to increase nursing coverage. A final goal of the fellowship will be to produce a research proposal to look at the role of altruism and other incentives in the decisions made by doctors in their relationship to their patients. The production of this proposal will be supported by a series of training modules in theoretical and empirical research methods, and the development of a small pilot project destined to test some possible tools.

Technical Summary

The aim of this MRC/ESRC fellowship in Health Economics is to boost the applicant‘s developing career as a promising health economist. To achieve this, the Fellowship is intended to support the successful completion of six specific objectives:
1. The writing-up of five papers arising from the applicant‘s thesis on the determinants of nurses‘ career choices in South Africa. Several papers will be published in economic journals and provide novel insights into economic tools and frameworks, while others will provide tools relevant for policy-makers in their attempts to design interventions to attract health workers to underserved areas;
2. The dissemination of the applicant‘s PhD results both to academic and policy audiences. This will be achieved through professional meetings and workshops, face-to-face meetings with key-stakeholders in South Africa, distribution of policy briefs and posting on relevant websites.
3. The undertaking of unique training opportunities in behavioural economic theory and stated preference techniques to the applicant. This is expected to strengthen the Fellow‘s research skills and provide opportunities for networking. These skills are also expected to be directly applied by the applicant in other research activities undertaken during the fellowship;
4. The analysis of follow-up data collected in South Africa on the same sample of nurses used for the Fellow‘s PhD. This will provide a unique opportunity to apply the econometric models combining Revealed and Stated preferences and investigate the extent to which the latter are good predictors of individuals‘ actual choices;
5. The implementation of a small research project intended to explore the role of health providers‘ altruism in the agency relationship. This would rely on methods and concepts introduced in the applicant‘s PhD and further developed during her training;
6. The development of a research proposal to secure further funding. The writing-up of the proposal will be supported by the training attended during the fellowship and the pilot project developed at an earlier stage.
Overall this Fellowship application supports the development of research products and ideas that are both original and highly policy-relevant. The originality of this research lies firstly in the use of methods (experimental economic games) and frameworks (behavioural economics) that are new in the field of health economics, and secondly in original applications of more standard tools for health economists (Markov models and economic analysis). These developments ultimately inform key policy issues such as the shortage of health workers in rural areas or the control of supplier-induced demand.
 
Description Internal peer-reviewed grant allocation of the RESYST Research Programme Consortium
Amount £63,730 (GBP)
Organisation Government of the UK 
Department Department for International Development (DfID)
Sector Public
Country United Kingdom
Start 01/2012 
End 12/2018
 
Description South African collaboration 
Organisation University of the Witwatersrand
Department Centre for Health Policy
Country South Africa 
Sector Academic/University 
PI Contribution We have carried out one main research project in the past (cohort study on within which my PhD was built) - During the course of my fellowship, we have obtained funding for a new project together on health workers' behaviours under different types of incentives. This benefits the South African institution directly (financial support).
Collaborator Contribution This collaboration has mainly consisted in an fruitful intellectual collaboration with one researcher, on two areas of research: analysis and development of Discrete Choice Experiments, and design of experimental economic games. This collaboration also provides facilitated access to sites for primary data collection (that would otherwise be more complex to obtain).
Impact several publications have come out of this: - Cost-effectiveness analysis of human resources policy interventions to address the shortage of nurses in rural South Africa; - Appealing to altruism: an alternative strategy to address the health workforce crisis in developing countries? - Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment. One funded project: - An experimental investigation of the impact of individual payment mechanisms on clinicians' behaviour
Start Year 2008
 
Description Bergen 2011 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach Regional
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact I was invited to the University of Bergen to give a presentation of my PhD work, particularly focusing on the link between experimental economics games and Discrete Choice Experiments. A small but interested audience of 10+ economists attended. Details of the presentation are:
Lagarde, M., Blaauw D, Smith R "An experimental investigation of nurses' altruism and its role in job choices: a cross-country study". Invited presentation at the Department of Economics, University of Bergen, 22nd February 2011, Bergen, Norway.

I have on-going discussion with an economist from the University of Bergen (Dr Julie Kolstad) to develop work together.
Year(s) Of Engagement Activity 2011
 
Description Imperial 2012 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach Local
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact I was invited to present some of my work at a seminar of the Business School of Imperal College London. There was a small audience of specialists, mostly health economists.
Lagarde, M "Investigating attribute non-attendance and its consequences in choice experiments with latent class models", Invited presentation at the Imperial College Business School Healthcare Management external seminar, 3 April 2012

No particular impact arose from that activity
Year(s) Of Engagement Activity 2012
 
Description Oxford 2012 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach Local
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact I have been invited to present some of my work at the Health Economics Research Centre of the University of Oxford.
Details of the presentation are:
Lagarde, M., Blaauw D "Do altruistic individuals choose rural jobs? Evidence from nurses in South Africa" Invited presentation at the Health Economics Research Centre, University of Oxford, 6 Dec 2012

No impact has arisen yet (this activity will take place next week).
Year(s) Of Engagement Activity 2012
 
Description Sydney 2011 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach Regional
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact I was invited to give a presentation of my Phd work at the University of Sydney, in front of an audience of 20+ academics (both health economists and public health specialists). Details of the presentation:
Lagarde, M., Blaauw D, Cairns J "Using Discrete Choice Experiments to investigate the relative cost-effectiveness of policy interventions to address nurses' shortages in rural South Africa" , Invited presentation at the Health Economics Seminar, University of Sydney, George Institute for International Health, 13 Jan 2011, Sydney, Australia.

No notable impact arose from this activity.
Year(s) Of Engagement Activity 2011
 
Description WHO Launch 2010 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Paper Presentation
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact I was invited as an expert to contribute to the discussions on research issues on health workforce at the official Launch of the WHO Global Recommendations on retention of health workers. The audience consisted both of international academics and key stake-holders.
The key message of my talk was to attract attention about the challenges to carry out research on these issues in LMICs.
Lagarde M, Blaauw D "Challenges and opportunities for research into retention of health care workers" Launch of the WHO Global Recommendations and Joint Symposium on Rural Health 7-9 September 2010, University of the Witwatersrand Medical School, Johannesburg, South Africa

This presentation led to discussion and links with staff from the World Bank to carry out some work with them. Discussions are currently being held to develop a research project in Benin.
Year(s) Of Engagement Activity 2010