Giving and promising gifts: Experimental evidence on reciprocity from the field

Abstract

We test the value of unconditional non-monetary gifts as a way to improve health worker performance in a low income country health setting. We randomly assigned health workers to different gift treatments within a program that visited health workers, measured performance and encouraged them to provide high quality care for their patients. We show that unconditional non-monetary gifts improve performance by 20 percent over a six-week period, compared to the control group. We compare the impact of the unconditional gift to one in which a gift is offered conditional on meeting a performance target and show that only the unconditional gift results in a statistically significant improvement. This demonstrates that organizations can improve the performance of health workers in the medium term without using financial incentives.

Keywords: C93; Field experiment; Gift exchange; Health care; I1; J41; O1; Reciprocity; Tanzania.

Figure 1. Timing of Intervention

Shaded boxes indicate periods of data collection using patient exit interviews. Arrows indicate one-on-one visits between research team and clinician participants. The randomization took place after the baseline data collection and before the encouragement visit. No data were collected on days when encouragement and follow-up visits occurred.