Non-Incentivized Service Spillover Effect
RCTReview
Policy makers often fear that paying targeted bonuses for specific healthcare tasks will cause workers to neglect non-paid routine health duties or erode intrinsic prosocial motivation.
Picture this
Paying a worker a targeted fee to visit a specific house (such as a mother who just had a baby) opens the door for a general relationship. Once inside, the worker naturally provides additional non-paid care (like checking on a sick child) because building trust and goodwill increases overall community demand for the worker's broader services.
What the evidence says
Households in treatment villages saw an 8.1 percentage point increase (71% increase from 11.4% baseline) in incentivized newborn visits and a concurrent 6.1 percentage point increase (73% increase from 8.4% baseline) in non-incentivized sick-child follow-up visits.
- Who was studied
- ~7,000 households in 214 villages (115 treatment, 99 comparison) in rural Uganda.
- How
- Randomized Controlled Trial (RCT) comparing rates of incentivized postnatal visits ($0.65 payment) against non-incentivized follow-up visits for child illness (malaria/diarrhea).
What to do
Design targeted financial micro-incentives for high-priority maternal and neonatal visits without restricting health promoters from delivering general non-incentivized primary consultation during the same visit.
From the source
"Relative to the comparison group, households in CHP villages were more likely to receive services that CHPs were incentivized to perform... Yet, households also experienced an increase in services that were not directly incentivized."
in-the-business-of-saving-lives.pdf