title: Precommitting to serve the underserved.
abstract: In many countries worldwide, especially in sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas.
authors.affiliation: Harvard Medical School Division of Medical Ethics, The Harvard University Program in Ethics and Health, 641 Huntington Avenue, Boston, MA 02115, USA. nir_eyal@hms.harvard.edu
authors.forename: Nir
authors.initials: N
authors.lastname: Eyal
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
mesh_terms: D017954:Africa South of the Sahara; D002321:Career Choice; D002755:Choice Behavior / Q000941:ethics; D003068:Coercion; D032982:Contracts / Q000191:economics / Q000941:ethics*; D008192:Deception; D003906:Developing Countries; D004501:Education, Medical / Q000191:economics*; D026689:Ethical Analysis; D005257:Fellowships and Scholarships / Q000191:economics / Q000941:ethics; D006801:Humans; D008507:Medically Underserved Area; D010820:Physicians / Q000191:economics / Q000600:supply & distribution*; D019035:Rural Health Services / Q000592:standards / Q000600:supply & distribution* / Q000639:trends; D013337:Students, Medical