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

Lead Research Organisation: London School of Hygiene & Tropical Medicine
Department Name: Public Health and Policy


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.


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