Recent evidence has highlighted the power of ‘non-financial incentives’ – i.e., rewarding and punishing behavior through social rather than monetary means – to improve the performance of individuals performing public service. Such incentive schemes are cheap, target individuals’ intrinsic motivation (i.e. desire to do good), and avoid a host of problems associated with administering financial incentive schemes.
IGC researchers Oeindrila Dube, Johannes Haushofer, and Bilal Siddiqi, in partnership with the Government of Sierra Leone and the World Bank, conduct a randomized controlled trial of two such non-financial incentives programs to increase social accountability in Sierra Leone's public health sector. Both programs use scorecards based on user behavior and feedback to reward or evaluate the performance of public health providers. However, the programs differ in terms of the exact nature of the incentive.
In the first, `top-down', intervention, health clinics compete on scorecard criteria and receive non-financial awards for good performance. In the second, `bottom-up' intervention, clinic staff and community members are motivated using scorecards to develop joint action plans to improve community health and monitor their providers.
The study finds no effects of the non-financial awards intervention on key health outcomes. In contrast, households in community monitoring villages are 11% more likely to use the clinic, 27% less likely to pay illegal fees, and 44% less likely to have a child who is ‘wasted’ (i.e. has extremely low weight for age). However, the intervention has no effects on child immunization, antenatal care, absenteeism, and staff attitude.
These results provide hopeful evidence for `bottom-up' non-financial incentives as a means to improve health outcomes in low-resource environments.