Incentivizing Community Health Workers in Guinea-Bissau: Experimental Evidence on Social Status and Intrinsic Motivation∗

Community Health Workers (CHWs) constitute a fundamental component of health systems in the developing world. Still, they are typically volunteers. This paper follows all the CHWs in the capital city of Guinea-Bissau and tests the impact of different types of nonfinancial incentives on CHW performance and household health. Specifically, we conducted a randomized field experiment around two main sources of incentives: (i) an honorific award for good performance aimed at raising the social status of CHWs; (ii) a video treatment centered on the task significance of CHWs targeting an increase in their intrinsic motivation. We also test variations of the video, the role of household awareness about the CHWs, and complementarity between the treatments. We employ administrative data on CHWs, as well as CHW and household survey data to measure outcomes. We find that the social status intervention improves CHW performance in terms of CHW learning about health practices with an impact on household health, in particular of children under 5 years old. Effects of the task significance video are weaker, like those of other treatments and interactions. The main implication is that inexpensive status awards can improve the performance of health workers. JEL codes: O12, D91, I15.