Financial Incentives and Healthcare Provision: Evidence from an Experimental Aedes aegypti Control Programme in Brazil

BackgroundMosquito control is the most effective means of reducing Aedes 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 findingsWe 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/SignificanceA. aegypti control programmes may benefit from alternative compensation schemes, especially 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. Author SummaryDiseases transmitted by the Aedes aegypti mosquito, such as chikungunya, dengue, yellow fever, and Zika, continue to affect thousands of people per year. As there are no safe vaccines for most of these infections, insecticide spraying and breeding site elimination are the best means to fight the mosquito. In several developing countries, which host the majority of A. aegypti infections, anti-mosquito campaigns are carried out inconsistently, thus it is crucial to find ways to improve the productivity of healthcare workers in charge of these tasks. We designed a randomised field experiment that provided individual and collective financial incentives to healthcare agents in a Brazilian city, and we tested the effect of monetary rewards on their productivity and on city-level dengue hospitalisations. We find that financial bonuses improved the number of cleaned breeding sites in both treatment groups (individual and team incentives) and that the collective treatment also improved larvae extermination. The impact of our treatment on city-level hospitalisations was not consistent across all specifications. In sum, financial incentives may be used to boost field productivity in anti-A. aegypti programmes, but further research is required to evaluate how healthcare worker productivity impacts dengue outcomes.