Chiu Calvin, Mnyippembe Agatha, Sheira Lila A, Packel Laura, Katabaro Emmanuel, Maokola Werner, Liu Jenny X
Institute for Health and Aging, University of California San Francisco, San Francisco, California, United States of America.
Health For A Prosperous Nation, Dar es Salaam, Tanzania.
PLoS One. 2025 Sep 11;20(9):e0330989. doi: 10.1371/journal.pone.0330989. eCollection 2025.
Non-financial incentives are frequently used to improve performance among healthcare providers, capitalizing on mission-driven intrinsic pro-social motivation. However, the effectiveness of incentives varies across settings and may depend on whether they are provided privately or publicly. Using a cluster-randomized controlled trial (ClinicalTrials.gov: NCT05525533) among drug shopkeepers in Tanzania, we designed and evaluated the effectiveness of non-financial incentives in boosting provider performance.
We developed a non-financial incentive that involved providing shopkeepers with monthly reports of aggregated customer feedback compiled from anonymous surveys from young women (15-24) to appeal to shopkeepers' pro-social motivation for helping these customers. We randomized whether the feedback was provided privately (via a report) or publicly (displaying certificates of the customer feedback ratings). We estimated linear regression models on provider performance as measured by sales across different categories to young women from administrative point-of sales data over 12 months and estimated whether performance measures were correlated with shopkeepers' pro-social motivation and concern for social image measured by surveys at Baseline.
Young women customers completed 9,108 anonymous surveys across 99 shops. Shops receiving non-financial incentives privately did not increase performance. However, shops receiving non-financial incentives publicly reported an increase in sales to young women customers (58%, 95% CI: 20%, 97%), most notably for sexual and reproductive health products (96%, 95% CI: 4%, 187%), specifically oral contraception (154%, 95% CI: 9%, 306%) and pregnancy tests (75%, 95% CI: 8%, 143%). Performance measures were correlated with concern for social image but not pro-social motivation at baseline.
Publicly provided non-financial incentives increased performance among drug shopkeepers in Tanzania serving young women. Performance was strongest among those with higher concern for their social image at baseline, rather than those with stronger pro-social motivation. Future interventions using non-financial incentives to motivate healthcare providers should consider leveraging providers' social image concerns to amplify the effectiveness of incentives.
非财务激励措施经常被用于提高医疗服务提供者的绩效，利用使命驱动的内在亲社会动机。然而，激励措施的有效性因环境而异，可能取决于它们是私下提供还是公开提供。我们在坦桑尼亚的药店店主中进行了一项整群随机对照试验（ClinicalTrials.gov：NCT05525533），设计并评估了非财务激励措施在提高提供者绩效方面的有效性。
我们制定了一项非财务激励措施，即每月向店主提供汇总的客户反馈报告，这些反馈来自对年轻女性（15 - 24岁）的匿名调查，以激发店主帮助这些客户的亲社会动机。我们随机决定反馈是私下提供（通过报告）还是公开提供（展示客户反馈评级证书）。我们根据12个月行政销售点数据中不同类别向年轻女性的销售额来衡量提供者绩效，估计线性回归模型，并估计绩效指标是否与店主在基线时通过调查衡量的亲社会动机和对社会形象的关注相关。
年轻女性客户在99家商店完成了9108份匿名调查。私下接受非财务激励的商店业绩没有提高。然而，公开接受非财务激励的商店报告称，向年轻女性客户的销售额有所增加（58%，95%置信区间：20%，97%），最显著的是性健康和生殖健康产品（96%，95%置信区间：4%，187%），特别是口服避孕药（154%，95%置信区间：9%，306%）和验孕棒（75%，95%置信区间：8%，143%）。绩效指标与基线时对社会形象的关注相关，但与亲社会动机无关。
公开提供的非财务激励措施提高了坦桑尼亚为年轻女性服务的药店店主的绩效。在基线时对社会形象关注度较高的店主中，绩效提升最为明显，而不是那些亲社会动机较强的店主。未来利用非财务激励措施激励医疗服务提供者的干预措施应考虑利用提供者对社会形象的关注来增强激励措施的有效性。
