How can we quickly assess the knowledge and motivation of health workers, particularly in remote areas of resource constrained countries? The question is of great interest since the perceived challenge of health care in poor countries is the degree to which existing compensation schemes are sufficient to attract qualified, motivated health workers, particularly (but not only) to work in remote areas and serve the poor.
To address this issue, we created a computerized real effort task, based on video vignettes representing typical maternal and child care cases, designed to efficiently measure health worker ability, and paired it with behavioral games to measure motivation. We describe the task and protocol for assessing ability and motivation. We then worked with about 1,000 health workers in Burkina Faso in a lab-in-the-field experiment to find out whether performance-based pay affects the effort and care that the subjects invested in watching and analyzing the video vignettes.
Focusing on equity issues, results indicate that health workers are sensitive to incentives for treating the poor. Under a flat salary or with a general performance-based bonus that does not explicitly target services for the poor, health workers tend to attempt more cases of non-poor patients which are modeled as simpler and shorter. When the poor cannot afford to pay for treatment, workers further reduce the quantity of care among poor patients, and increase the quantity of care among non-poor patients. Introducing a bonus which explicitly rewards service for the poor is effective in increasing the quantity of care among the poor and reducing inequity.