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

33 Pages Posted: 7 Dec 2018 Last revised: 8 Dec 2018

See all articles by Sheheryar Banuri

Sheheryar Banuri

University of East Anglia (UEA) - School of Economic and Social Studies; University of East Anglia (UEA) - Centre for Behavioural and Experimental Social Science (CBESS)

Damien de Walque

World Bank; World Bank - Development Research Group (DECRG)

Philip Keefer

Inter-American Development Bank

Paul Jacob Robyn

Cameroon Country Office

Date Written: December 6, 2018

Abstract

Do service providers respond to pecuniary incentives to serve the poor? Service delivery to the poor is complicated by the extra effort required to deliver services to them and the intrinsic incentives of service providers to exert this effort. Incentive schemes typically fail to account for these complications. A lab-in-the-field experiment with nearly 400 health workers in rural Burkina Faso provides strong evidence that the interaction of effort costs, ability, and intrinsic and extrinsic incentives significantly influences service delivery to the poor. Health workers reviewed video vignettes of medical cases involving poor and nonpoor patients under a variety of bonus schemes. Bonuses to serve the poor have less impact on effort than bonuses to serve the nonpoor; health workers who receive equal bonuses to serve poor and nonpoor patients see fewer poor patients than workers who receive only a flat salary; and bonuses operate largely through their influence onthe behavior of pro-poor workers. The paper also presents novel evidence on the selection effects of contract type: pro-poor workers prefer the flat salary contract to the variable salary contract.

Keywords: Health Care Services Industry, Health Service Management and Delivery, Population & Development, Educational Sciences

Suggested Citation

Banuri, Sheheryar and de Walque, Damien and Keefer, Philip and Robyn, Paul Jacob, Encouraging Service Delivery to the Poor: Does Money Talk When Health Workers are Pro-Poor? (December 6, 2018). World Bank Policy Research Working Paper No. 8666, Available at SSRN: https://ssrn.com/abstract=3297322

Sheheryar Banuri (Contact Author)

University of East Anglia (UEA) - School of Economic and Social Studies ( email )

Norwich, Norfolk NR4 7TJ
United Kingdom
+441603591246 (Phone)

HOME PAGE: http://https://www.uea.ac.uk/economics/people/profile/s-banuri

University of East Anglia (UEA) - Centre for Behavioural and Experimental Social Science (CBESS) ( email )

United Kingdom
+441603591246 (Phone)

Damien De Walque

World Bank ( email )

1818 H Street, N.W.
Washington, DC 20433
United States

HOME PAGE: http://econ.worldbank.org/staff/ddewalque

World Bank - Development Research Group (DECRG)

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

Philip Keefer

Inter-American Development Bank ( email )

1300 New York Ave., NW
Washington, DC 20577
United States
202-623-1961 (Phone)

Paul Jacob Robyn

Cameroon Country Office ( email )

Yaoundé
Cameroon

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