Recruiting and motivating community health workers: Measuring impact through a nationwide household survey

This is a follow-up project from Recruiting and motivating health workers in Zambia.

We study how career incentives affect who selects into public health jobs and, through selection, their performance while in service. We collaborate with the Government of Zambia to design a field experiment embedded in the national recruitment campaign for a new health worker position. To identify the selection effect of incentives we experimentally vary the salience of career incentives at the recruitment stage, which triggers selection responses, but we offer the same incentives to all recruited agents, which mutes effort responses. Career incentives attract health workers who provide more inputs (29% more household visits, twice as many community meetings) and this is matched by an increase in institutional deliveries, breastfeeding, immunizations, deworming and a 5pp reduction in the share of underweight children. The results allay the concern that extrinsic rewards worsen public service delivery by crowding out pro-social agents.