Selection, Performance of Health Workers and State Legitimacy

• Applicant: Dr. Dietmar Fehr
• Subject Area: Economic Policy, Applied Economics
• Term: since 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 509527065

The lack of state capacity is a critical impediment for economic development in many low-income countries. This often culminates in an inability to provide basic public services, which in turn contributes to a further reduction of the legitimacy of the state. In the proposed research project, we look at a major determinant of public service quality and state capacity: the quality of public employees. While better selection of employees by the state can have direct and large effects on the quality of public services and subsequently on state legitimacy, the job application process in developing countries can be prohibitively costly preventing talented workers to select into the applicant pool. The aim of the planned project is to study whether lowering search frictions improve the selection of public employees and public service provision and subsequently increase state legitimacy in the eyes of its citizens. The focus will be on two important components of search frictions that are particularly prevalent in a development context: barriers on information about job opportunities and application costs. Our study context is the provision of public health services in rural Pakistan. This context is well suited for our purposes because the services are performed by community health workers who directly determine the quality of the services they provide and whose performance can be objectively measured. We will run a field study in 200 randomly selected communities, including a baseline survey of the universe of eligible applicants and a randomized controlled trial that varies the different components of search frictions we focus on. Therefore, our setup will allow us (i) to directly identify the impact of search frictions on the selection of community health workers and subsequent public service quality and (ii) to identify their impact on state legitimacy through better service quality, within a single framework. In addition, this framework will allow us to provide a detailed account of self-selection into the applicant pool based on the baseline survey data and to scrutinize the role of the screening process for service quality.The findings of this project are of high relevance as understanding selection of public employees is crucial for improving public sector governance. Moreover, the current pandemic has highlighted the importance of an efficient health system. Strengthening the ability to deliver better public health services is essential for successfully dealing with potentially more frequently recurring pandemics and other health emergencies.

• DFG Programme: Research Grants
• International Connection: USA
• Co-Investigator: Karrar Hussain, Ph.D.
• Cooperation Partner: Muhammad Yasir Khan, Ph.D.