This study takes place in the context of the Community Health Worker Program in Sierra Leone. The health program is structured around PHUs, each composed of one peer supervisors (PS) and an average of 9 community health workers (CHW) per PS. CHWs are the frontline workers: they are in charge of visiting households in their villages and provide basic health services: inform them about health, treat/diagnose diseases (whenever possible) and provide ante- or post-natal services. Each CHW is trained, supervised and advised by the peer supervisor (PS) in their corresponding health unit. All CHWs and PSs are entitled to a total monthly compensation of, respectively, SLL 150,000 and SLL 250,000, by the Ministry of Health and Sanitation (MOHS). [$1.00 = SLL 8,450.00] When a supervisor decides to quit her position, one of the 9 health workers she supervises is promoted to the supervisor position.
Until mid-2018, promotions from CHW to PS position were made at the discretion of the head of each PHU and therefore mostly based on personal connections, rather than merit. Starting then, the District Health Officials have committed — in a random half of the 372 PHUs — to use objective performance information as the main input for their promotion decisions (“Meritocracy Treatment”). Performance will be measured through a reporting system that exists in all PHUs. All CHWs in the Meritocracy Treatment are informed about the new promotion system, while CHWs who are not assigned to the Meritocracy Treatment are reminded of the current promotion system.
The experiment further creates random variation at the PHU level in perceived wage steepness. In a random half of the PHUs (stratified by the Meritocracy Treatment), CHWs are informed about the wage gap between their own salary and the supervisor’s salary (Wage Gap Treatment), which they underestimate at baseline. In the other half of the PHUs, CHWs are not informed about the wage gap. We will quantify the effect of the Wage Gap information treatment on the exact increase in CHWs' perceived wage gap through a survey. (More details below).