Scott S. Lee
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;