Using preference parameter estimates to optimise public sector wage contracts: A field study in Pakistan

• Polio is a major problem in Pakistan with more than 300 confirmed cases reported in 2014

• Weak monitoring and flat incentive structures are key reasons for the dismal quality of public vaccination campaigns

• This study uses mobile based monitoring and bonuses to improve performance of polio eradication campaign workers

Polio is a major problem in Pakistan with more than 300 confirmed cases in 2014. Weak monitoring and flat incentive structures are key reasons for the dismal quality of public vaccination campaigns. Under the current immunisation system, records of vaccination coverage remain unreliable. Vaccinators use paper-based records and are typically assigned an overly ambitious number of vaccinations to complete. Consequently, it is generally accepted that vaccinators will miss their targets, but under-report their performance failures because results are difficult to verify.

This project used lessons from a previous project funded by the IGC which used ICT technologies to improve monitoring of health facilities. The new project designed a mobile phone-based monitoring system for the polio eradication staff working with the District Health Department in Lahore. The workers were asked to set targets for themselves within a given range. They were required to set the targets for the first two days of the campaign and if they achieved their daily targets they would qualify for a bonus, which doubled their earnings from the campaign.

The research team found that it is nearly impossible for third-party auditors to verify the total number of vaccinations performed by a worker, based on the paper-based form. They also found that monetary incentives result in extra effort from the worker, which is reflected in the increased number of vaccinations. The results from behavioural experiments suggest that tailored contracts help in reducing procrastination, which is a major issue in the public service delivery.

Findings from the study were shared in high level meetings with Commissioner Lahore Division and DCO Lahore City. The government has expressed interest in follow up of the study.