HOW DO CAREER BENEFITS AFFECT THE RECRUITMENT AND PRODUCTIVITY OF CIVIL SERVICE AGENTS?

Responsible researcher: Bruno Benevit

Original title: Losing Prosociality in the Quest for Talent? Sorting, Selection, and Productivity in the Delivery of Public Services

Authors: Nava Ashraf, Oriana Bandiera, Edward Davenport and Scott S. Lee

Intervention Location: Zambia

Sample Size: 1,585 adults

Sector: Healthcare

Variable of Main Interest: Prosocial motivation

Intervention Type: Career Benefits

Methodology: OLS, DID

Summary

The trade-off between health agents' skills and commitment can be a crucial aspect in explaining the quality of health services, indicating a duality between extrinsic and intrinsic rewards. To analyze how these incentives are interrelated, the authors of this article carried out an experiment in a national recruitment process carried out in Zambia to evaluate whether the offer of career benefits causes the hiring of less pro-social professionals. The results demonstrate that this phenomenon was only observed among low-skill agents, and that agents who chose the career option are more talented and equally pro-social. Additionally, the treatment led to improvements in several indicators of patient health and agent productivity in the treated districts.

1. Policy Problem

The quality of public services is a critical aspect for economic development. The topic has great relevance when related to the provision of health services in rural regions, generating debates about the possibility that the selection of health agents involves a trade-off between qualifications and skills compared to pro-social inclination (Ashraf et al. , 2020). According to the authors, as economic incentives (extrinsic rewards) represent greater attractiveness for health agents with greater qualifications and skills, greater local affinity and pro-social inclination (intrinsic rewards) motivate the choice of more committed and engaged professionals. with the function performed.

In Zambia, much of the primary health care in remote rural areas occurs through the provision of services by informal agents linked to religious and charitable organizations. With the aim of professionalizing the provision of health services, the government of Zambia created a new position of health worker in the public service, called Community Health Assistant (CHW). The first recruitment and training for this new modality took place in 2010. The ACS should carry out home visits and referrals to health units. Therefore, this professional needs both the technical skills to carry out screening, anamnesis, first aid and referral, as well as the social competence to advise, support and guide patients.

In this sense, offering career benefits in the selection process of these agents can attract more qualified health agents, but with less pro-social engagement. Although both predicates positively affect service provision, the marginal gains of these characteristics in the quality of service provision and health indicators are uncertain. Furthermore, due to the shortage of medical professionals, the application of this measure may result in great disparities in the quality of the service provided, highlighting the importance of evaluating this public policy.

2. Implementation and Evaluation Context

The trial took place in conjunction with the national recruitment campaign for a new healthcare position in Zambia. To verify whether career benefits attract talent to the detriment of pro-social motivation, the experiment was carried out using two types of posters, one for the treated group and the other for the control group. Recruitment was carried out randomly in 48 districts stratified by province and district level of education. The poster for the group of treated districts recruited agents for the new position of career worker, and the poster for the group of control districts was aimed at those interested in the informal modality with non-governmental organizations, which was in force until then. The two types of advertisements differed only in relation to the dissemination of career opportunities, requiring the same prerequisites for both types.

During the recruitment process, the selection panel looked at general skills, cognitive (IQ) and non-cognitive skills (ambition, persistence and work ethic), and pro-social skills, determined by the perceived usefulness generated by helping others. others. The candidates' cognitive abilities were measured based on their 12th grade final exam score and the number of subjects studied in biology and other natural sciences. Non-cognitive skills considered professional ambition, measured according to the candidates' self-declared aspirations regarding their career. To measure prosociality, the authors considered the candidate's self-reported willingness to remain in the community long-term (5 to 10 years after the interview), in addition to the result of alignment of interests on the "Inclusion of Others in the Self" scale. IOS)" (Aron et al. , 2004).

3. Policy/Program Details

In the first year of the program, in 2010, the government began the recruitment and training process for each of the 167 communities in 48 districts. The selection panels were responsible for choosing the two candidates to work as community agents at the health posts in each community. These panels were made up of five members: the district health officer, a representative from the health center associated with the health post, and three members of the local neighborhood health committee. In total, recruitment included 2,457 registrations, of which 1,585 participants were considered for the analyzes carried out in this study. Ultimately, 334 candidates were recruited as incumbents and 413 as reserves for 47 districts (one was excluded from the sample by not sending candidates to ACS). Selected health professionals become contractually obligated to the positions for one year, and CHWs must wait two years before applying for higher positions.

4. Method

In order to control for possible selection bias in relation to skills between the treated and control groups, surveys were carried out before and after training by health agents to verify differences in aspects of ambition and prosocial preferences of those recruited. . The authors also carried out a test to verify the existence of a difference between the importance given to general and pro-social skills between the panels of the treated and control groups during the selection process.

Subsequently, the article presented a series of analyzes related to the productivity of health services provided using the ordinary least squares method. Using the ordinary least squares (OLS) method, the first set of analyzes verified the impact of treatment (the effect of CHW career opportunities) on the number of visits in the first 18 months after treatment. Together, the authors analyzed whether there was a difference in the services provided after the end of the 1-year position, observing the presence of compensation effects of treatment that affected the quality of visits, community meetings and emergency calls.

The second set of analyzes looked at whether the treatment affected the use of health facility facilities in the treated districts. To this end, the difference-in-differences (DID) method was used to verify the effect of treatment in health units after the intervention, that is, the integration of CHAs into these units.

Finally, the OLS method was adopted for the third set of analyzes to verify the impact of the treatment in terms of health practices, disease incidence and anthropometric indicators of malnutrition and diseases for mothers and children in the communities.

5. Main Results

The analysis regarding the preferences of those recruited indicates that the groups differed before training, but there was convergence in the agents' preferences after training, and only candidates with low skill levels from the treated districts showed significant and smaller differences in pro- sociability in relation to control districts. In general, this behavior indicates comparability between candidates from both groups, making it possible to separate the effect of selection from the effect of incentives associated with the type of position. Additionally, the results indicated that the selection panels for both recruitments valued the candidates' characteristics in the same way.

When analyzing the impact of CHWs' career opportunities on the number of visits in the first 18 months, the authors identified a large effect caused by the treatment, such that 13,818 visits would have been carried out if agents in the control group had carried out as many visits as the treated group. . Regarding the effect on the quality of care after the initial 18 months, the results demonstrated that CHAs dedicate the same time to care, are equally likely to visit target patients (mothers and children), and provide care in more homes and more visits monitoring. Furthermore, no compensation effects were identified in the execution of secondary activities, on the contrary, positive effects of CHAs were observed in the number of community meetings and patients treated at the health center.

The results of the analyzes on the effect of treatment on the use of health unit facilities showed significant positive results in several aspects. The districts that had ACSs observed significant increases of 30% in the number of births performed in health centers, 24% in the number of visits to children, 22% in the number of children undergoing weighing, and 20% in the number of children vaccinated for polio.

The intervention also resulted in advances in relation to patients' health practices, disease incidence and malnutrition rates. The presence of CHWs resulted in an increase in the likelihood of children being breastfed until 2 years of age, of adopting appropriate practices for managing children's waste, and of children being up to date with their immunization schedule. In terms of health results, children showed a drop in the chance of having a cough in the last two weeks before the interview and a reduction in the incidence of malnutrition indicators.

6. Public Policy Lessons   

This article presented evidence that the offer of public service positions with career opportunities for community work attracts agents who provide health services. In general, this behavior does not imply a reduction in the level of pro-sociality of health agents, and the offer of positions led to an improvement in the quality and frequency of services provided in districts that had CHAs. Access to these services resulted in improvements in the care and health indicators of children in the respective communities.

Although the results of this study demonstrate the effectiveness of this type of policy, the authors emphasize that the selection mechanisms are usually not random. In this sense, policy makers must be careful when adopting strategies that properly select the most suitable candidates to occupy the desired positions, making correct incentives necessary for those recruited and recruiters.

References

Aron, A., McLaughlin-Volpe, T., Mashek, D., Lewandowski, G., Wright, SC, and Aron, EN (2004) Including others in the self. European Review of Social Psychology , 15 (1), 101–132.

Ashraf, N., Bandiera, O., Davenport, E., and Lee, S.S. (2020) Losing Prosociality in the Quest for Talent? Sorting, Selection, and Productivity in the Delivery of Public Services. American Economic Review , 110 (5), 1355–1394.