The best evidence yet on how Theories of Change are being used in aid and development work

August 29, 2014

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August 29, 2014

Good research, great video: what’s the best way to motivate community health workers?

August 29, 2014
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Some more innovative work from the London School of Economics. This genuinely thought-provoking 8 minute video describes a collaboration between the LSE-hosted International Growth Centre and Zambia’s Ministry Zambia CHW1 Zambia CHW2of Health. The background academic paper is here.

Researchers and officials worked together to answer an important question:  to motivate people in rural villages to become rural community health workers (CHWs), is it best to appeal to their community spirit, or to their hopes for individual career development? If you do the latter, will people lose their link to the community, and replicate the problem with more standard professional health workers, many of whom hate working in rural areas, and head for the city?

To do that, they divided up 160 villages targeted for recruitment. In half they put up posters that stressed ‘come and serve your community’, in the rest they put the emphasis on careers (see pics). Sure enough, the posters attracted different kinds of people to apply for CHW training.

So what happened? The paper concludes:

‘We find that making career incentives salient attracts more qualified applicants with stronger career ambitions without displacing pro-social preferences, which are high in both treatments. Health workers attracted by career incentives are more effective at delivering health services and are equally likely to remain in their posts over the course of 18 months. Career incentives, far from selecting the “wrong” types, attract talented workers who deliver health services effectively.’

There are important lessons here. Firstly, the way to generate research – the IGC built long term relationships with the Ministry of Health, meaning that they could work together on the basis of trust and respect. The very opposite of the ‘extractive research’ that is all too common in academia. (‘I need access to your community for my research’).

The findings suggest that career incentives work better and do not lead to an exodus of staff. However, one caveat – to be certain, you would want to follow the CHWs over a longer period of time than 18 months to test for desertion rates.

One other caveat – it still feels very top down. LSE pointy heads workshopping busily with Ministry officials and sympathetic politicians and agreeing what tests to run on the communities in terms of recruitment strategies. What would the research have looked like if they’d designed it with the involvement of CHWs or the communities themselves? Rather different, I imagine.

It all goes some way to restoring my faith in the value of randomization and experimental approaches, when done well. And of course, it’s a brilliantly accessible way to publicise research findings.

Here’s the video summary:

[h/t Hugh Cole]

2 comments

  1. Would the adverts have been even more successful if they had asked people to “Become a Community Health Worker” rather than “Become a CHW”?

    but the rest of the article still makes a lot of sense, despite this initial gripe.

  2. Very interesting experiment, resonating with what feminist economists have long argued: that material reward doesn’t crowd out intrinsic motivations. An important thing though: do these career promises actually materialize? Considering that most CHWs are probably volunteers (and women!): are there real prospects of them moving on to paid employment.

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