Provider Retaliation Threat Deterrence
RCTClinical Trial
In participatory monitoring systems, service providers may use counter-sanctions or informal retaliation against citizens who lodge complaints. When providers possess retaliatory power, accountability mechanisms suffer diminished efficacy in boosting service quality.
Picture this
Think of a tenant reporting a landlord for broken plumbing, but the landlord has the legal authority to double the rent in response. Because the tenant anticipates this costly payback, the landlord feels less pressure to fix the plumbing in the first place, weakening the incentive to deliver good service.
What the evidence says
The threat of provider retaliation muted provider reciprocity increases from 42 percentage points down to 26 percentage points relative to the Complaint Box control (a reduction from a 40% increase to a 25% increase over the control mean of 1.039) and suppressed patient complaint card intensity from 1.053 extra cards down to 0.190 cards (p = 0.033 for difference in card intensity between PD and PD-R).
- Who was studied
- N = 103 health providers (77 public sector, 26 private sector) and 216 patients across 93 health facilities in Nairobi, Kenya.
- How
- Lab-in-the-field experiment comparing the Peer Disclosure treatment against a Peer Disclosure with Retaliation treatment where providers could levy a 150 KES monetary penalty on complaining patients.
What to do
Structurally insulate citizen whistleblowers from provider counter-sanctions by stripping service providers of discretionary punishment authority and concealing patient identities.
From the source
"When provider retaliation is allowed, the effectiveness of the Peer Disclosure reporting system, with respect to provider reciprocity, is reduced to between 22 and 25 percentage points relative to the Complaint Box (approximately 21 to 24 percent)."
e7b318f7-c10f-44ea-935a-6f4ab3cde66a-Health Workers’ Behavior, Patient Reporting and Reputational Concerns- Lab-in-the-Field Experimental Evidence from Kenya.pdf