The incentives and constraints shaping the behaviour of health service staff are increasingly recognised to be the key determinants of how effectively public healthcare systems deliver services, particularly at the community level. This paper presents new evidence about the personal and professional motivations and incentives of government doctors in Bangladesh. Based on original research in government primary health care facilities in Bangladesh, the paper explores three motivating contextual factors relating to how doctors behave in rural government health facilities: a) resource levels and management conditions; b) conditions of governance and accountability, including institutionalised practices of corruption and formal and informal mechanisms for creating pressures for accountability to patients and communities; and c) social, personal and domestic factors.