Abstract
We experimentally evaluated the effects of in-kind team incentives on health worker performance in El Salvador, with 38 out of 75 community health teams randomly assigned to performance incentives over a 12-month period. All teams received monitoring, performance feedback and recognition for their achievements allowing us to isolate the effect of the incentive. While both treatment and control groups exhibit improvements in performance measures over time, the in-kind incentives generated significant improvements in community outreach, quality of care, timeliness of care, and utilization of maternal and child health services after 12 months. Gains were largest for teams at the bottom and top of the baseline performance distribution. We find no evidence of results being driven by changes in reporting or by shifting away effort from non-contracted outcomes. These results suggest that in-kind team incentives may be a viable alternative to monetary or individual incentives in certain contexts.
Highlights
Deficient health provider performance has been documented in multiple middle and low-income countries, including failure to meet coverage targets, absenteeism from post of duty, noncompliance with clinical guidelines and even malpractice (Berendes et al, 2011, Das and Hammer, 2004, 2007; Das et al, 2013, Banerjee et al, 2004; Barber et al, 2007; Planas et al 2015)
We study the effects of in-kind group incentives for community health teams in El Salvador’s public sector
The overall performance score is the aggregate weighted measure of targets met by a health team, with weights equal to the points established for each indicator (Table 2)
Summary
Deficient health provider performance has been documented in multiple middle and low-income countries, including failure to meet coverage targets, absenteeism from post of duty, noncompliance with clinical guidelines and even malpractice (Berendes et al, 2011, Das and Hammer, 2004, 2007; Das et al, 2013, Banerjee et al, 2004; Barber et al, 2007; Planas et al 2015). We study the effects of in-kind group incentives for community health teams in El Salvador’s public sector. All health teams received the same performance feedback, supervision, and recognition for their achievements, allowing us to isolate the effect of the in-kind incentives. Substantial gains were achieved by health teams with the lowest baseline performance, whose gains centered on activities requiring less team member coordination such as quality of care which is influenced mostly by physicians, and community outreach, which is mostly the responsibility of community health workers. While the literature discusses some common concerns of non-linear schemes, such a potential failure to motivate those further away from performance targets (Miller and Babiarz, 2014), to our knowledge there is little empirical evidence on this.
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