Recruiting and Compensating Civil Servants: A Large-Scale Field Experiment in Zambia (CHWs)

The recruitment and selection process occurred at the community (health post) level, with on-the-ground implementation coordinated by district health officials. In each community, paper advertisements for the job were posted in local public spaces, such as schools, churches, and the health post itself. The treatment poster makes career incentives salient. To do so it lists, as the main benefit, the opportunity to ascend the civil-service career ladder to higher and better-paid positions, which are illustrated and enumerated in the poster--e.g., environmental health technician, nurse, clinical officer, and doctor. This incentive is summarized in a bold caption stating, "Become a community health worker to gain skills and boost your career!" In this setting, the pay gradient associated with career advancement is steep, as the starting monthly wage is USD 290 for CHAs, USD 530 for entry-level nurses, USD 615 for environmental health technicians, and USD 1,625 for resident doctors. The control poster, in contrast, lists as the main benefit the opportunity to contribute to one's community, such as "[gaining] the skills you need to prevent illness and promote health for your family and neighbors" and "[being] a respected leader in your community." This incentive is summarized in a caption stating, "Want to serve your community? Become a community health worker!" Potential applicants exposed to the control poster are thus presented with a description akin to the informal community health workers that are common in these areas, a position they would be familiar with.

2011-06-01

2014-01-31

Pro-social and career preferences, ability, performance, retention, use of health services

Pro-social and career preferences: Applicants recruited under both approaches displayed similar levels of pro-social preferences: about 84 percent of both groups perceived their self-interest as overlapping with their community' s interests, and a little over half planned to stay in the same community for the next 5-10 years. However, applicants recruited by making career incentives salient were more ambitious regarding career advancement: a larger portion aspired to hold a higher-ranking government position in the next 5-10 years.

Ability: Applicants recruited by making career incentives salient had higher secondary school graduation exam scores overall and in natural sciences.

Performance: During the first 18 months of work, CHAs recruited by making career incentives salient conducted 94 more household visits than those recruited in the social incentives group, who conducted an average of 319 visits. They did not achieve these gains by targeting easy-to-reach households or by spending less time on each visit. CHAs in the career benefits group also hosted almost twice as many community meetings (an average of 43 meetings, compared with 22 meetings in the community benefits group). The effect on performance was driven by high-performing CHAs in the career incentives group—workers who would not have been recruited if they had not seen materials emphasizing opportunities for career advancement.

Retention: There was no evidence that career incentives improved performance at the expense of retention. During the first six months after the CHAs' one-year commitment period, the number of dropouts was similar across both groups. None of the CHAs who left did so for a higher-ranking position within the Ministry of Health because the Ministry requires CHAs to work for two years before applying for promotion.

Use of health services: In communities with CHAs recruited by making career incentives salient, the number of women giving birth at health centers increased by 14 per quarter from an average of 47 in comparison communities (a 30 percent increase). This suggests that the greater number of household visits performed by CHAs may have prompted people to make better use of the health services available to them.

The experiment aims to identify the effect of career incentives on performance through selection. We use the recruitment posters described above to experimentally vary the salience of career incentives at the recruitment stage so as to engineer an exogenous change in selection. Once recruited, all CHAs face the same incentives; thus performance differences, if any, are due to selection. Since recruitment for the CHA position was organized by district officials, we randomized treatment at the district level in order to maximize compliance with the experimental assignment, evenly splitting the 48 districts into two groups. This implies that each district official is only exposed to one treatment and is unaware of the other. As district officials are the main source of information for aspiring CHAs, randomization at the district level minimizes the risk of contamination.

Computer randomization

District level

Yes

48 districts

The government received over 2,400 applications and interviewed 1,585 eligible candidates. Then, 314 candidates attended a year-long training, and 307 graduated and began work as CHAs.

Treatment: 24 districts
Control: 24 districts

We study how career incentives affect who selects into public health jobs and, through selection,
their performance while in service. We collaborate with the Government of Zambia to
experimentally vary the salience of career incentives in a newly created health worker position
when recruiting agents nationally. We find that making career incentives salient at the recruitment
stage attracts health workers who are more effective at delivering health services, and administrative
data show an improvement in institutional deliveries, child visits and immunization
in the treatment areas. While career incentives attract agents who differ on observables—they
have higher skills and career ambitions—91% of the performance gap is due to unobservables.
The results highlight the importance of incentive design at the recruitment stage as a tool to
improve performance in organizations.

Ashraf, Nava, Oriana Bandiera, and Scott Lee. "Do-Gooders and Go-Getters: Career Incentives, Selection, and Performance in Public Service Delivery." Working Paper, February 2015.

https://www.povertyactionlab.org/sites/default/files/publications/400%20Do-gooders%20Feb2015.pdf