Summary

The health sector, both in India and in Uttar Pradesh (UP), faces multiple challenges in the geographic distribution of human resources. Though the majority of the population lives in rural areas, doctors in both the public and private sectors are concentrated in urban areas. The WHO estimates that over 80 per cent of qualified private providers are concentrated in urban areas. This has resulted in the majority of rural households receiving care from private providers, many of whom are less than fully qualified, thus hampering access to quality health services.
Financial incentives alone do not attract health workers to rural areas. Other than salary, factors such as access to training, health care, education for children, promotion, improved working and living conditions play an important part in their choice. Thus, incentive packages that address several aspects of employment choice are likely to be most successful in recruiting health workers to rural areas.
Vacancies in the public health sector are acute. Figures from 2001 suggest that 40percent of the medical officer posts in PHCs and 50percent of the specialist posts in CHCs are lying vacant (Government of India).
This study aims to understand the determinants of employment choice among graduating medical and nursing students in UP. It has three main objectives:
(1) To examine job attributes that graduating medical and nursing students consider important when seeking their first job. 
(2) To explore medical and nursing students’ perspectives on jobs in the public and private sector, and on the urban and rural working environments.
(3) To understand the influence of monetary and non-monetary incentives on medical and nursing students' decision on whether to serve in a rural, public sector job upon graduation.

Background

The health sector, both in India as a whole and in the state of Uttar Pradesh (UP), faces multiple challenges in the geographic distribution of human resources for health. Though the majority of the population lives in rural areas, doctors in both the public and private sectors are concentrated in urban areas. While the public sector has made considerable efforts to place doctors (and a variety of other health workers) in rural areas, issues such as absenteeism and dual practice have compromised this effort. The distribution of private providers is also highly skewed; one study estimates that over 80 per cent of the qualified private provider market is concentrated in urban areas (WHO 2007). Female doctors and other categories of health workers are likely to be similarly mal-distributed. The lack of qualified medical professionals in rural areas has resulted in the majority of rural households receiving care from private providers, many of whom are less than fully qualified (WHO 2007). This geographic imbalance in the health workforce hampers the ability of rural populations to access quality health services.