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incentives

Why doctors leave their posts – problem-solving irregularities in the health sector with healthcare workers in Bangladesh

Mushtaq Khan's picture

It’s not often you get together the very people working on the frontline to sit down together and discuss why and how irregular practices occur in their sector – and what can be done about them. But that’s just what we did with a group of frontline health workers at a workshop in Bangladesh’s capital Dhaka in December 2017. We wanted to understand why corrupt and irregular practices occur in the health sector - what are the underlying incentives and processes? And what are some feasible and impactful ways to change these practices?

Many developing countries, including the three where our research consortium, the Anti-Corruption Evidence research consortium is working, Bangladesh, Nigeria and Tanzania, struggle to provide free or low-cost healthcare to all their citizens. Instead, citizens are often forced to buy services from the private sector at higher fees or worse, approach untrained or traditional healers. There is agreement in the literature that a large proportion of these inefficiencies occur due to corrupt practices (though there’s an active debate about whether using the c-word is helpful in this debate, which is why we talked about ‘irregularities’ during this workshop). Many of these practices are related to the way societies in developing countries are organized around patron-client relations, where tax resources are insufficient, and resources, jobs and promotions require lobbying powerful politicians.

Beyond the status quo: Using impact evaluation for innovation in health policy

Marcus Holmlund's picture

How do we deliver higher-quality health services in low-capacity settings? 
 
This is the question that we have sought to answer through a long-standing impact evaluation (IE) research collaboration with the Nigerian Ministry of Health and the Bill & Melinda Gates Foundation. The results of this collaboration will be presented at the World Bank on February 8 at Beyond the Status Quo: Using Impact Evaluation for Innovation in Health Policy. This one-day event will bring together policymakers, practitioners, and academics to discuss policy implications and ways to further promote and strengthen capacity for evidence-informed policy.

Can incentives lead to sustained impacts? The case of rewarding safe sex.

Damien de Walque's picture
Economists believe that incentives matter and that they can be used for changing people’s behaviors. Incentives are used for encouraging school attendance and performance or for increasing the coverage and quality of health care delivery. But a recurrent question is what happens once the incentives are discontinued? Are the incentives’ effects going to be sustained even after their payment is stopped because individuals would have been nudged towards a different behavior? Or are those effects going to die down and disappear once incentives are removed?

DFID is Changing its Approach to Better Address the Underlying Causes of Poverty and Conflict – Can it Work? Guest Post from two DFID Reformers

Duncan Green's picture

Aid donors are often maligned for bureaucratic procedures, a focus on short-term results at the expense of longer-term, riskier institutional change, and a technical, managerial approach to aid with insufficient focus on context, power and politics. Are these institutional barriers insurmountable? Can aid agencies create an enabling environment to think and work politically? 

Tom WingfieldTom Wingfield (top) and Pete Vowles (bottom) from DFID’s new ‘Better Delivery Taskforce’ have been trying to do just that. Here’s where they’ve got to.

For the past year DFID has been focussing on these issues and how we can both guard taxpayer’s money and have transformational impact in the countries where we work. The result has been the introduction of a comprehensive set of reforms targeting our process, capability and culture. Pete VowlesThis is about creating the conditions that allow us to better address the underlying causes of poverty and conflict, and respond effectively to the post-2015 agenda. At the heart of the reform is a revamp of DFID’s operating framework (ie the rules and principles which govern our work). Known as the ‘Smart Rules’, it can be downloaded here.

Like any institutional reform, this is a long term change process.  The next 12 months provide a real opportunity to strengthen our partnerships with a wide range of partners and enhance our collective effectiveness.

The Accountability Lab: Does Money Pervert Incentives?

Roxanne Bauer's picture
Which is more important to development: systemic change or small-scale projects? Which has a greater impact: money or social capital?  Most people responding to these questions are tempted to say systemic change and material resources are the most important factors in lifting people out of poverty. 

However, others working in the development sector, like Blair Glencorse of Accountability Lab, argue that money can actually pervert incentives. He states, "all of our projects are very small-scale [...] but the emphasis is on financial resources actually being less valuable than some other resources like intellectual capital, relationships, networks." 

Accountability Lab believes that making power-holders accountable leads to more responsible decisions and actions. In turn, resources are used more efficiently and expectations for further reform are generated, ensuring continued demand for accountability. This is not a clear-cut process, and it is often beset by difficulty. Sudden or massive increases in funding for certain sectors can negatively impact the process and do not lead to lasting accountability of power-holders. 

Watch the video and let us know if you agree! 
 
Does Money Pervert Incentives?

The Things We Do: How (not What) Movies Inspire Us

Roxanne Bauer's picture

At the basis of communication and public policy are assumptions about human beings- their rationality or irrationality, their foibles, wants and preferences. A lot depends on whether these assumptions are correct. In this feature, we bring you fascinating examples of human behavior from across the globe.

A recent article in The New York Times, “Divining Why One Film Spurs Activism, While Others Falter” highlights the work of Participant Media, an entertainment company that produces film, television, publishing and digital content that inspires social change. According to Participant Media’s website, the company “launches campaigns that bring together government entities, foundations, schools, and others to raise awareness and drive people to take action on issues from each film or television show.” 

But all of this begs the question: are these films successful in doing what they set out to do? Do people learn from the films and change their ways?  What pushes us beyond social media activism to stand up and do something about our outrage?

When field studies diverge from lab experiments: the case of incentivized blood donations: Guest post by Mario Macis

Do economic incentives crowd out individuals’ intrinsic motivation for certain activities that are performed in the absence of explicit rewards, such as volunteering in soup kitchens, recycling, or giving blood? This is an important question with implications for public policy and has been explored on Development Impact with a number of recent posts (here is the latest one from Jed).

What makes bureaucracies work better? Lessons from the Nigerian Civil Service

Markus Goldstein's picture
Given Jed's post last week on thinking through performance incentives for health workers, and the fact that the World Bank is in the throes of a reform process itself, a fascinating new paper from Imran Rasul and Daniel Rogger on autonomy and performance based incentives in Nigeria gives us some other food for thought.   In a nutshell, Rasul and Rogger f

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