A cross-country comparison of nurses’ altruistic motives

Presenter: Mylene Lagarde, London School of Hygiene and Tropical Medicine

Abstract

Rationale: Recent developments in behavioural economics have focused on the existence and role of social preferences, which are defined as the concern for others’ wellbeing compared to one’s own self-interest. Exploring the role of social preferences is important in the design of interventions aimed at influencing individual choices.

Social preferences are potentially relevant to the analysis of job decisions made by public sector workers. A number of surveys and qualitative studies suggest the importance of other types of motivations, beyond narrow self-interest, including vocation (‘helping the community’) or altruism (‘serving others’). For example, some studies of nurses suggest that professional identity directly relates to vocational and altruistic motivations, and that nurses are less interested in monetary incentives.

Investigating social preferences can provide new insights into how to motivate new workers, retain existing workers and encourage the return of those who have left the country or the profession. These issues are particularly relevant in developing countries where scarce public resources are allocated to the training of health workers who then leave the public sector or are reluctant to work in areas where they are needed most.

Objectives: This paper presents the results of surveys and behavioural economics games conducted to provide new evidence on the nature and determinants of altruism amongst nurses in developing countries.

Methodology: Approximately 1,000 final year nursing students from Kenya, South Africa and Thailand participated in a framed Dictator Game (DG) where they had to decide how much to give to three different recipients (another student, a patient or a poor person). To facilitate comparability across countries, the stakes were set relative to the salary that a newly-qualified nurse would receive in each country. Participants were also surveyed about their socio-demographic characteristics, job intentions, and vocational attitudes.

Results: The presentation will present the determinants of altruistic preferences across individual respondents, through discussing the relative role of individual characteristics and attitudinal variables. The correlation of measure of altruism with intentions to work in the public vs. private sector (or rural vs. urban areas) will also be examined. The differences in determinants of altruistic preferences between countries will be presented. Finally, we will present a comparison of survey and experimental measures of altruism, and discuss our results compared to other findings in the experimental economics literature.

Conclusion: This study is the first to use experimental economics combined with surveys to compare the nature and determinants of nurses’ altruism in three different developing countries, and explore their links to vocational motives. Social preferences (altruism, reciprocity, trust) have proven to be important in other fields and should be investigated in future research on health personnel attitudes and behaviours.