Healthcare Delivery in Sierra Leone

Over the past decade, the Government of Sierra Leone (GoSL) has made a concerted effort to improve health care services throughout the country, including an ambitious free health care initiative launched in 2010. Key to the success of the initiative was strengthening the weak incentives faced by front-line health providers—for example, in early 2010, a large share of health staff were compensated entirely through informal fee payments from users and margins from drug sales. To alleviate basic resource constraints, the GoSL increased worker salaries and the flow of resources to clinics nationwide, and sought to introduce non-financial incentive schemes, which recent studies have shown to be highly effective in improving worker performance in a range of environments. However, could such schemes be applied to Sierra Leone’s health sector, and if so, what types of non-financial incentives would work best?

To answer this question, the GoSL, in conjunction with the World Bank, the Center for the Study of African Economies, and Innovations for Poverty Action, launched a randomized controlled trial to test the effectiveness of two innovative interventions using non-financial incentives to improve health care outcomes. The first intervention involved community monitoring of health clinics through the use of health scorecards and collaborative meetings between community members and health staff. The second intervention used non-financial awards, such as public commendations, with the aim of improving worker motivation and promoting greater efficiency within health clinics. This document is an analysis plan for gauging the effects of these interventions, and builds on an initial report released by Innovations for Poverty Action in 2014.