Encouraging Service Delivery to the Poor : Does Money Talk When Health Workers Are Pro-Poor?

Banuri, Sheheryar ; de Walque, Damien ; Keeper, Philip ; Robyn, Paul Jacob

World Bank, Washington, DC

关键词: SERVICE DELIVERY;    HEALTH SERVICES;    PUBLIC HEALTH;    ACCESS TO HEALTH CARE SERVICE;    HEALTH WORKERS;   

DOI  :  10.1596/1813-9450-8666
RP-ID  :  WPS8666

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Do service providers respond topecuniary incentives to serve the poor? Service delivery tothe poor is complicated by the extra effort required todeliver services to them and the intrinsic incentives ofservice providers to exert this effort. Incentive schemestypically fail to account for these complications. Alab-in-the-field experiment with nearly 400 health workersin rural Burkina Faso provides strong evidence that theinteraction of effort costs, ability, and intrinsic andextrinsic incentives significantly influences servicedelivery to the poor. Health workers reviewed videovignettes of medical cases involving poor and nonpoorpatients under a variety of bonus schemes. Bonuses to servethe poor have less impact on effort than bonuses to servethe nonpoor; health workers who receive equal bonuses toserve poor and nonpoor patients see fewer poor patients thanworkers who receive only a flat salary; and bonuses operatelargely through their influence on the behavior of pro-poorworkers. The paper also presents novel evidence on theselection effects of contract type: pro-poor workers preferthe flat salary contract to the variable salary contract.