1888. What Do Doctors Want? Developing Incentives for Doctors to Serve in Indonesia's Rural and Remote Areas

Kenneth M. Chomitz, Gunawan Setiadi, Azrul Azwar, Nusye Ismail, and Widiyarti
(March 1998)

Like many large countries, Indonesia has difficulty attracting doctors to service in rural and remote areas. The promise of specialist training is an effective but expensive inducement for service in remote areas. It might help to increase the representation of Outer Island students in medical schools, as they are more willing to serve in remote areas.

Like many large countries, Indonesia has difficulty attracting doctors to service in rural and remote areas. To guide the creation of incentives for service in these areas, Chomitz and colleagues analyze two sets of data about physicians: (1) the locations chosen by graduating medical students before and after a major change in the incentive system, and (2) survey data on choices among hypothetical assignments differing in compensation, career prospects, and amenities at various locations.

Their findings suggest that:

• The current policy of offering specialist training is incentive enough to make doctors from Java willing to serve in remote areas. (It is not necessary to also offer a civil service appointment.) But providing specialist training as an incentive to work in remote areas is not only expensive, but potentially inefficient, since specialist practice and rural public health management require different skills and attitudes.
• Moderately (but not extremely) remote areas can be staffed using modest cash incentives.
• Doctors from the Outer Islands are far more willing to serve in remote areas than their counterparts from Java. So, it may be worthwhile increasing the representation of Outer Island students in medical schools (perhaps through scholarships and assistance in pre-university preparation).

This paper—a product of the Development Research Group—is part of a larger effort in the group to develop methods to analyze public policy in the health sector. The study was funded by the Bank's Research Support Budget under the research project "Incentives for Doctor Placement in Rural and Remote Areas" (RPO 681-56). Copies of this paper are available free from the World Bank, 1818 H Street NW, Washington, DC 20433. Please contact Teri Charvet, room MC2-522, telephone 202-458-7431, fax 202-522-3230, Internet address mcharvet@worldbank.org. (43 pages)

The full report is available in PDF format.