Provider Retaliation Threat Deterrence

In Simple Words

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.

Research question

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.

Participants

N = 103 health providers (77 public sector, 26 private sector) and 216 patients across 93 health facilities in Nairobi, Kenya.

Study Design

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.

Results

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).

Takeaway

Structurally insulate citizen whistleblowers from provider counter-sanctions by stripping service providers of discretionary punishment authority and concealing patient identities.

Read alongside the research

Plain-English glossary

Original explanations, informed by the references below. Examples are illustrations, not data from the studies above. The research text stays unchanged.

Percentage points

The difference between two percentages.

ExampleA rise from 40% to 50% is 10 percentage points. Relative to the starting value, that is a 25% increase.

Office for National Statistics · Percentages ↗Read more about percentage points →

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