Financial Incentives and Healthcare Provision: Evidence from an Experimental Aedes aegypti Control Programme in Brazil
Background. Mosquito control is the most effective means of reducing A. aegypti infections worldwide. In many developing countries, however, vector management programmes fail to reach their goals due to low worker productivity. Research suggests that financial incentives may increase the productivity of health personnel, yet there is little evidence about the impact of monetary rewards on A. aegypti-reduction strategies. We evaluated whether individual and collective financial incentives improve the performance of healthcare workers fighting A. aegypti, as well as their effect on city-level numbers of dengue hospitalisations. Methodology/Principal findings. We hired and trained subjects to visit households, find A. aegypti breeding sites, and eliminate mosquito larvae in the city of Rio Verde, Brazil. We randomly assigned workers into three groups. The control group received a flat compensation for their tasks, while workers in the two treatment groups received individual and collective monetary bonuses, respectively. Financial rewards increased the number of cleaned breeding sites in both treatment groups (individual and team bonuses) and the collective treatment also improved larvae extermination. The intervention lowered dengue hospitalisations in 10.3%, but the result was not consistent across all model specifications. Conclusions/Significance. A. aegypti control programmes may benefit from alternative compensation schemes, specially when provided to teams. For this strategy to succeed, financial incentives have to be distributed widely as their aggregate effect is limited. More research is needed to assess whether higher worker productivity decreases dengue hospitalisations. Keywords: Aedes aegypti, dengue, financial incentives, mosquito control, preventive healthcare, randomised field experiment, worker productivity