Encouraging Service Delivery to the Poor
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World Bank, Washington, DC
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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 on the 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.
Palabras clave
SERVICE DELIVERY, HEALTH SERVICES, PUBLIC HEALTH, ACCESS TO HEALTH CARE SERVICE, HEALTH WORKERS, INEQUALITY