Oriana Bandiera describes the close collaboration between a team of economists and the Government of Zambia to evaluate strategies to recruit, motivate and retain agents in the rollout of its National Community Health Assistant Programme. Using a randomised experiment the findings illustrate that there is no tradeoff between career incentives, skills and social values. Providing career opportunities attracts more skilled individuals who perform better and seem to be equally socially motivated. The findings also provide empirical insight into how governments can implement and manage large-scale civil service initiatives.
The civil service – public cadres of bureaucrats, local administrators, teachers and health workers – is a key component of the state’s capacity to govern and provide public goods. In the effort to create an effective civil service, states face key questions regarding how to recruit, train and motivate competent agents to ensure their high performance and long-term retention. A new film by the International Growth Centre, based at the LSE, shows how economists and policymakers can collaborate to answer these key questions.
Click here to watch the short film: Health Workers in Zambia – Co-Producing Knowledge (Youtube)
In 2010, the Government of Zambia launched a new civil service cadre: the Community Health Assistant (CHA). Recruited from local communities, trained and then posted back in their communities, Community Health Assistants are a policy response to the shortage of formal health workers in rural areas of the country. Together with fellow researchers at Harvard, I have collaborated with the Zambian Government’s Ministry of Health since the inception of the CHA program, when the first cohort of 307 CHAs was recruited from 160 communities in 48 districts across the country. Thereafter, the Ministry of Health will recruit 1,000 Community Health Assistants per year for five years, totaling 5,000 CHAs nationwide.
Using a randomised experiment we evaluated strategies to recruit, motivate and retain agents in this civil service post. The experiment was designed to measure the practical relevance of a particular concern of the Ministry, namely whether providing career opportunities came at the expense of community attachment and interest for the social good, therefore reducing motivation and performance. Randomised experiments (or randomised controlled trials) are the most rigorous method to evaluate quantitatively the causal impact of a policy on the outcomes of interest. They are, however, typically constrained to cover a small area or population. In this instance, the collaboration with the Ministry allowed us to implement a unique nationwide experiment.
The key idea is that pro-social preferences can interact with other sources of motivation such as the attainment of material benefits through financial gain or career advancement. Understanding the nature of this interaction is crucial to identify how best to attract and motivate agents engaged in public services delivery. The observation that material incentives are less common in organizations that deliver public services is consistent with the fact that pro-social preferences can be an alternative source of motivation to material incentives, but it does not provide information on how the two interact. Do material benefits leverage pro-social preferences and attract qualified agents who deliver public services effectively? Or do they crowd out pro-social preferences and attract agents who solely pursue their private interests at the expense of service quality?
To answer these questions we experimentally varied the salience of career benefits vs. social benefits across all 48 districts when recruiting agents. We then followed the entire first cohort from application to the field and measured impacts at every stage: we collected information on the skills and pro-social preferences of the applicants, analyzed how they are selected and, finally, how they performed once hired during the course of one year.
We found that the different recruitment strategies indeed matter: they attract different types at application stage, and they affect performance in the field.
- At the application stage, we found that applicants to both treatments display strong pro-social preferences, thus suggesting that making career benefits salient does not displace pro-social motivation. However, making career incentives salient attracts applicants who are more qualified (as measured by high school test scores) and have a stronger scientific background (measured by the number of natural sciences courses taken and passed). The differences are driven by the fact that career incentives attract more qualified applicants as opposed to discouraging less qualified applicants. This has important implications for the skill level of those who are eventually selected for the job as qualified candidates can be chosen only if they apply.
- At the deployment stage, we compared the performance of CHAs in their main tasks: household visits, community mobilisation meetings and visiting patients at the health post. We found that CHAs recruited with career incentives conduct 26% more household visits and organize twice as many community meetings while seeing the same number of patients at the health post. Supplementary evidence suggests that the difference does not come at the expense of quality measured by the length of the visits, targeting of women and children, or the balance between new and repeat visits
After one year, retention rates are identical in both groups but longer-term data is required to establish the effects on retention in the long-run. If retention is lower in the ‘career’ treatment, the welfare implications of using the career poster rest on the value of strong performers in communities for a shorter period versus weaker performers for a longer period (as well as what happens to strong performers when they leave, and the value they might bring to the health sector if they build further skills and remain within the Ministry of Health). Regardless of the retention outcomes, however, the findings clearly illustrate that there is no tradeoff between career incentives, skills and social values. Providing career opportunities attracts more skilled individuals who perform better and seem to be equally socially motivated.
This project has been designed and implemented in close collaboration with the Government of Zambia, in particular the Ministry of Health. The Ministry of Health is committed to an evidence-based, learning-driven approach to national policy, which is reflected in its decision to incorporate research into the rollout of the National Community Health Assistant Programme. The findings provide empirical insight into how governments can implement and manage large-scale civil service initiatives. In addition, it is hoped that they will advance theoretical understanding about the complex interplay between job design, incentives, selection and performance.
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Professor Oriana Bandiera is Professor of Economics and Director of the Suntory and Toyota International Centres for Economics and Related Disciplines (STICERD) at the LSE.