Open Access Research article

Willingness to work in rural areas and the role of intrinsic versus extrinsic professional motivations - a survey of medical students in Ghana

Peter Agyei-Baffour1*, S Rani Kotha2, Jennifer C Johnson2, Mawuli Gyakobo3, Kwesi Asabir4, Janet Kwansah5, Emmanuel Nakua1, Mawuli Dzodzomenyo6, Rachel C Snow7 and Margaret E Kruk8

Author Affiliations

1 Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

2 Center for Global Health, University of Michigan, Galleria Building, 1214 S. University Ave, 2nd Floor Suite C, Ann Arbor, Michigan 48104, USA

3 c/o Office of the Provost, College of Health Sciences, University of Ghana, PO Box KB 52, Legon, Ghana

4 Ministry of Health, Human Resource for Health Directorate, P.O.Box M44, Accra, Ghana

5 Ministry of Health, Policy, Planning, Monitoring, and Evaluation Directorate, PO Box M44, Accra, Ghana

6 School of Public Health, Department of Biological, Environmental and Occupational Health Sciences, PO Box LG 13, University of Ghana, Legon, Ghana

7 Department of Health Behaviour and Health Education, School of Public Health, University of Michigan, USA

8 Department of Health Policy and Management, Columbia University Mailman School of Public Health, 600 W. 168th Street, Room 606, New York, NY 10032, USA

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BMC Medical Education 2011, 11:56  doi:10.1186/1472-6920-11-56

Published: 9 August 2011



Retaining health workers in rural areas is challenging for a number of reasons, ranging from personal preferences to difficult work conditions and low remuneration. This paper assesses the influence of intrinsic and extrinsic motivation on willingness to accept postings to deprived areas among medical students in Ghana.


A computer-based survey involving 302 fourth year medical students was conducted from May-August 2009. Logistic regression was used to assess the association between students' willingness to accept rural postings and their professional motivations, rural exposure and family parental professional and educational status (PPES).


Over 85% of students were born in urban areas and 57% came from affluent backgrounds. Nearly two-thirds of students reported strong intrinsic motivation to study medicine. After controlling for demographic characteristics and rural exposure, motivational factors did not influence willingness to practice in rural areas. High family PPES was consistently associated with lower willingness to work in rural areas.


Although most Ghanaian medical students are motivated to study medicine by the desire to help others, this does not translate into willingness to work in rural areas. Efforts should be made to build on intrinsic motivation during medical training and in designing rural postings, as well as favour lower PPES students for admission.

Health Manpower; Motivation; Rural Health Services; Ghana