Working Hard or Hardly Working: Health Worker Effort and Health Outcomes

Effort by health workers in developing countries has been the subject of much recent attention, but the implications, if any, for health outcomes have largely remained a matter of conjecture. This paper provides new empirical evidence about the returns to health worker effort. In this experiment, outpatient providers in Nigeria were assigned to an intervention in which their consultations were monitored by a peer. To elicit behavior under the counterfactual, the same group of clinicians was covertly observed. Exploiting the sharp increase in effort induced by peer monitoring, I document large, positive, and statistically significant improvements in health. These findings shed new light on potential gains from incentivizing health worker effort.