Precommitting to Serve the Underserved

Nir Eyal, Till Bärnighausen

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)23-34
Number of pages12
JournalAmerican Journal of Bioethics
Issue number5
StatePublished - May 2012
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Issues, ethics and legal aspects
  • Health Policy


  • developing countries
  • ethics
  • health workers
  • human resources for health
  • medically underserved areas
  • precommitment
  • scholarships


Dive into the research topics of 'Precommitting to Serve the Underserved'. Together they form a unique fingerprint.

Cite this