Scott Lee is an MD-PhD Candidate in Health Policy and Management at Harvard Medical School and Harvard Business School. His principal research interests lie in improving the delivery of primary health care both in the United States and, especially, in low- and middle-income countries. His dissertation research uses insights from organizational and behavioral economics to strengthen large-scale frontline health worker programs in sub-Saharan Africa and South Asia.
Scott graduated summa cum laude and Phi Beta Kappa from Harvard College in 2003 with a BA in medical anthropology, comparative religion, and African studies. He then completed an MPhil in environment and development as a Gates Scholar at the University of Cambridge and an MPA in health policy at Princeton's Woodrow Wilson School of Public and International Affairs. Since 2001, Scott has spent eight summers working in rural Kenya, where he has teamed with local villagers to establish a high school, a nursery school, a microfinance program, an agricultural training program, a computer training center, and a community health clinic. In 2006, Scott co-founded a nonprofit organization, Common Hope for Health, to support the Kenyan health clinic and other community-based health initiatives in low-resource settings. He has supplemented this hands-on experience with research and policy stints at the World Health Organization in Geneva, Partners In Health in Rwanda, and Brigham and Women’s Hospital in Boston.
Scott's work is supported by the Paul and Daisy Soros Fellowship for New Americans, the Weiss Family Program Fund, Grand Challenges Canada, the United States Agency for International Development, the Abdul Latif Jameel Poverty Action Lab, the UBS Optimus Foundation, the Massachusetts General Hospital Center for Global Health, and the International Growth Center.
Do-gooders and Go-getters: Career Incentives, Selection, and Performance in Public Service Delivery
We study how career incentives affect who selects into public health jobs and, through selection, their performance while in service. We collaborate with the Government of Zambia to experimentally vary the salience of career incentives in a newly created health worker position when recruiting agents nationally. We find that making career incentives salient at the recruitment stage attracts health workers who are more effective at delivering health services, conducting 29% more household visits and twice as many community mobilization meetings. Administrative and survey data show an improvement in institutional deliveries, child visits, breastfeeding, immunizations, deworming and a 25% reduction in the share of underweight children in the treatment areas. While career incentives attract agents who differ on observables—they have higher skills and career ambitions—91% of the performance gap is due to unobservables. The results show that incentive design at the recruitment stage can have dramatic impacts on the performance of organizations.
Keywords: Motivation and Incentives;
Partners In Health: HIV Care in Rwanda
In 2005, Partners in Health (PIH) was invited by the Rwandan Ministry of Health to assume responsibility for the management of public health care in two rural districts in Eastern Rwanda and create an HIV treatment program at these sites. PIH successfully implemented a comprehensive program focusing on four principles: health systems improvement, HIV prevention and care, accompaniment, and social and economic support. By January 2007, the Rwinkwavu site had conducted 67,137 HIV tests and provided antiretroviral therapy to more than 2,000 patients, of which, fewer than 1% had been switched to second-line drug regimens, 3.8% had died, and only one patient had been lost to follow up. A costing analysis done by the Clinton HIV/AIDS Initiative suggested that the model could feasibly be spread to other districts. Dr. Agnes Binagwaho, Executive Director of Rwanda's National AIDS Control Commission and her colleagues in the Ministry of Health are contemplating how the program could be improved and whether it should be expanded nationally.
Keywords: Developing Countries and Economies;
Health Care and Treatment;
Health Testing and Trials;
I am currently a Principal or Co-Principal Investigator of five field-based randomized controlled trials, each of which examines the management of lay health workers in developing countries, with an eye toward generating theoretical insights and policy guidance on how to maximize the productivity of health workers in developing as well as developed countries. The field experiments draw on incentive theory, behavioral economics, and organizational psychology.
In Zambia, with Nava Ashraf and Oriana Bandiera, I am working with the Zambian Ministry of Health on a series of national field experiments examining optimal approaches to recruiting, training, and motivating community health workers. We have now completed two out of three experiments. First, during the nationwide recruitment of the community health workers, we randomized different recruitment messages to examine how the mission of a social sector job (career advancement versus community service) affects the self-selection of applicants. Second, during the one-year training of the selected candidates, we randomized different recognition and award schemes to examine how these schemes affect performance during training. Analysis of both experiments is ongoing.
The third experiment in Zambia coincides with the graduation of the community health workers from training and their return to their home communities to begin work. In this context, we are experimentally examining how the allocation of decision rights between supervisors and workers for a key performance management process—the setting of performance goals—affects subsequent worker performance.
In Kenya and India, I am the Principal Investigator of two field experiments examining how mobile technology can improve the performance of community health workers.
The experiment in India examines how performance feedback may affect the motivation, engagement, and performance of community health workers. With computer science colleagues from Dimagi, Inc., a software company, and the University of Washington, I have developed a software application that provides automated, graphical performance reports to community health workers through their mobile phones. There is an abundant literature on how feedback and self-tracking can motivate work performance; this experiment will, to my knowledge, provide the first experimental evidence on how such mechanisms can affect the performance of lay health workers.
In Kenya, I am developing a project in which I hope to motivate community health workers to perform at a higher level by leveraging their prosocial preferences. Specifically, I will develop and test a mobile phone-based platform for strengthening prosocial motivation among community health workers in Kenya, who tend to be pro-socially motivated, but whose formal compensation systems currently focus exclusively on private incentives. How can programs systematically bring out the pro-social “best” in their workers, rather than rely on incentives that appeal to their self-interest only?
Keywords: Development Economics;