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Bureaucratic performance is a crucial determinant of economic growth. Little is known about how to improve it in resource-constrained settings. This study describes a field trial of a social recognition intervention to improve record keeping in clinics in two Nigerian states, replicating the intervention-implemented by a single organization-on bureaucrats performing identical tasks in both states. Social recognition improved performance in one state but had no effect in the other, highlighting both the potential and the limitations of behavioral interventions. Differences in observables did not explain cross-state differences in impacts, however, illustrating the limitations of observable-based approaches to external validity.
Behavioral Insights --- Bureaucracy --- Education --- Educational Sciences --- External Validity --- Gender --- Gender and Development --- Health Care Services Industry --- Healthcare --- Hydrology --- Industry --- Labor Markets --- Nudges --- Randomized Control Trial --- RCT --- Social Protections and Labor --- Water Resources
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There is building evidence in India that the delivery of health services suffers from an actual shortfall in trained health professionals, but also from unsatisfactory results of existing service providers working in the public and private sectors. This study focusses on the public sector and examines de facto institutional and governance arrangements that may give rise to well-documented provider behaviors such as absenteeism, which can adversely affect service delivery processes and outcomes. The paper considers four human resource management subsystems: postings, transfers, promotions, and disciplinary practices. The four subsystems are analyzed from the perspective of front line workers, that is, physicians working in rural health care facilities operated by two state governments. Physicians were sampled in one post-reform state that has instituted human resource management reforms and one pre-reform state that has not. The findings are based on quantitative and qualitative measurement. The results show that formal rules are undermined by a parallel modus operandi in which desirable posts are often determined by political connections and side payments. The evidence suggests an institutional environment in which formal rules of accountability are trumped by a parallel set of accountabilities. These systems appear so entrenched that reforms have borne no significant effect.
Governance --- Health Economics & Finance --- Health Monitoring & Evaluation --- Health Systems --- Health Systems Development & Reform --- Health, Nutrition and Population --- Human Resource Management --- Population Policies --- Public Management --- Public Sector Corruption and Anticorruption Measure --- Public Sector Development
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