Publication:
Love the Job... or the Patient?: Task vs. Mission-Based Motivations in Health Care

Loading...
Thumbnail Image
Files in English
English PDF (994.43 KB)
295 downloads
English Text (83.3 KB)
24 downloads
Date
2018-02
ISSN
Published
2018-02
Author(s)
Banuri, Sheheryar
Keefer, Philip
Editor(s)
Abstract
A booming literature has argued that mission-based motives are a central feature of mission-oriented labor markets. This paper shifts the focus to task-based motivation and finds that it yields significantly more effort than mission-based motivation. Moreover, in the presence of significant task motivation, mission motivation has no additional effect on effort. The evidence emerges from experiments with nearly 250 medical and nursing students in Burkina Faso. The students exert effort in three tasks, from boring to interesting. In addition, for half of the students, mission motivation is present: their effort on the task generates benefits for a charity. Two strong results emerge. First, task motivation has an economically important effect on effort, more than doubling effort. Second, mission motivation increases effort, but only for mundane tasks and not when the task is interesting. Moreover, even for mundane tasks, the effects of mission motivation appear to be less than those of task motivation.
Link to Data Set
Citation
Banuri, Sheheryar; Keefer, Philip; de Walque, Damien. 2018. Love the Job... or the Patient?: Task vs. Mission-Based Motivations in Health Care. Policy Research Working Paper;No. 8338. © World Bank. http://hdl.handle.net/10986/29372 License: CC BY 3.0 IGO.
Associated URLs
Associated content
Report Series
Report Series
Other publications in this report series
  • Publication
    Intergenerational Income Mobility around the World
    (Washington, DC: World Bank, 2025-07-09) Munoz, Ercio; Van der Weide, Roy
    This paper introduces a new global database with estimates of intergenerational income mobility for 87 countries, covering 84 percent of the world’s population. This marks a notable expansion of the cross-country evidence base on income mobility, particularly among low- and middle-income countries. The estimates indicate that the negative association between income mobility and inequality (known as the Great Gatsby Curve) continues to hold across this wider range of countries. The database also reveals a positive association between income mobility and national income per capita, suggesting that countries achieve higher levels of intergenerational mobility as they grow richer.
  • Publication
    Engineering Ukraine’s Wirtschaftswunder
    (Washington, DC: World Bank, 2025-07-29) Akcigit, Ufuk; Kilic, Furkan; Lall, Somik; Shpak, Solomiya
    As Ukraine emerges from the devastation of war, it faces a historic opportunity to engineer its own Wirtschaftswunder—a productivity-driven economic transformation akin to post-war West Germany. While investment-led growth may offer quick wins, it is efficiency, innovation, and institutional reform that will determine Ukraine’s long-term economic trajectory. Drawing on rich micro-level firm data spanning 25 years, this paper uncovers deep structural distortions that have suppressed creative destruction and productivity in Ukraine. It finds that business dynamism is on the decline, alongside rising market concentration among incumbent businesses, including low productivity state owned enterprises. To inform priorities for reviving business dynamism, this study develops a model of creative destruction drawing on Acemoglu et al. (2018) and Akcigit et al. (2021). The quantitative assessment highlights that policies that discipline entrenched incumbents are the bedrock for reviving business dynamism and engineer Ukraine’s Wirtschaftswunder. Policies targeting specific types of firms have limited efficacy when incumbents run wild.
  • Publication
    Fiscal Multipliers in Resource-Rich Economies: Evidence from the Gulf Countries
    (Washington, DC: World Bank, 2025-08-21) Chattha, Muhammad Khudadad; Kawalec, Tobias
    This paper utilizes the unique dynamics of fiscal budgeting in countries with a large hydro-carbon sector to estimate fiscal multipliers. The main identifying assumption rests on the idea that exogenously identified global hydrocarbon demand shocks can be considered plausible instruments for the fiscal space of countries in which that space is significantly dictated by hydrocarbon income, with such shocks being uncorrelated with non-hydrocarbon output at the same time. Using a local projection-instrumental variables (LP-IV) framework, the paper estimates that short-run fiscal expenditure multipliers to be in the ballpark of 0.1–0.4. In addition, the findings show that multipliers are at the upper end of this interval during recessions, indicating that fiscal policy in the Gulf countries is particularly effective during economic downturns.
  • Publication
    Stress Testing Survey to Survey Imputation: Understanding When Poverty Predictions Can Fail
    (Washington, DC: World Bank, 2025-08-21) Corral, Paul; Ham, Andres; Lanjouw, Peter; Lucchetti, Leonardo; Stemmler, Henry
    Accurate and timely poverty measurement is central to development policy, yet the availability of up-to-date high-quality household survey data remains limited—particularly in countries where poverty is most concentrated. Survey-to-survey imputation has emerged as a practical response to this challenge, allowing practitioners to update poverty estimates using recent surveys that lack direct welfare measures by borrowing information from other comprehensive surveys. A critical review of the method is provided, revisiting its statistical underpinnings and testing its limitations through extensive model-based simulations. Through these simulations, the analysis demonstrates how violations of parameter stability, omitted variable bias, and shifts in survey design can introduce substantial errors—particularly when imputing across time or under economic and structural change. Results show that standard corrections such as re-weighting or covariate standardization may fail to eliminate these biases, especially when imputing across time or under structural change. The performance of alternative model specifications is also evaluated under various methods, including performance under heteroskedastic errors, non-normality. The findings offer practical guidance for practitioners on when survey-to-survey imputation is likely to succeed, when it should be reconsidered, and how to communicate its limitations transparently in the context of poverty monitoring and policy design.
  • Publication
    The Future of Poverty
    (Washington, DC: World Bank, 2025-07-15) Fajardo-Gonzalez, Johanna; Nguyen, Minh C.; Corral, Paul
    Climate change is increasingly acknowledged as a critical issue with far-reaching socioeconomic implications that extend well beyond environmental concerns. Among the most pressing challenges is its impact on global poverty. This paper projects the potential impacts of unmitigated climate change on global poverty rates between 2023 and 2050. Building on a study that provided a detailed analysis of how temperature changes affect economic productivity, this paper integrates those findings with binned data from 217 countries, sourced from the World Bank’s Poverty and Inequality Platform. By simulating poverty rates and the number of poor under two climate change scenarios, the paper uncovers some alarming trends. One of the primary findings is that the number of people living in extreme poverty worldwide could be nearly doubled due to climate change. In all scenarios, Sub-Saharan Africa is projected to bear the brunt, contributing the largest number of poor people, with estimates ranging between 40.5 million and 73.5 million by 2050. Another significant finding is the disproportionate impact of inequality on poverty. Even small increases in inequality can lead to substantial rises in poverty levels. For instance, if every country’s Gini coefficient increases by just 1 percent between 2022 and 2050, an additional 8.8 million people could be pushed below the international poverty line by 2050. In a more extreme scenario, where every country’s Gini coefficient increases by 10 percent between 2022 and 2050, the number of people falling into poverty could rise by an additional 148.8 million relative to the baseline scenario. These findings underscore the urgent need for comprehensive climate policies that not only mitigate environmental impacts but also address socioeconomic vulnerabilities.
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    Was Weber Right?
    (World Bank, Washington, DC, 2015-05) Banuri, Sheheryar; Keefer, Philip
    This paper examines the effects of pecuniary compensation on the ability and motivation of individuals in organizations with non-pecuniary or pro-social missions. In particular, the paper compares flat pay systems, unrelated with ability or effort, to two other systems that are considered superior: high-powered, pay for performance schemes and more traditional, “Weberian” schemes that calibrate pay to ability, independent of effort. The analysis uses a sample of future public sector workers and finds that all three pay schemes attract motivated workers into tasks with a pro-social mission. However, flat pay schemes also attract low ability workers. In the short run, pay-for-performance schemes generate higher effort than flat pay and pay-for-ability systems, a difference driven entirely by effects on unmotivated workers. Once selection effects are accounted for, however, workers with pay for ability and pay for performance exert statistically indistinguishable levels of effort in the pro-social task. Moreover, pay for ability elicits effort at lower cost than pay for performance.
  • Publication
    Intrinsic Motivation, Effort and the Call to Public Service
    (World Bank, Washington, DC, 2013-12) Banuri, Sheheryar; Keefer, Philip
    Pay schemes in the public sector aim to attract motivated, high-ability applicants. A nascent literature has found positive effects of higher pay on ability and no or slightly positive effects on motivation. This paper revisits this issue with a novel subject pool, students destined for the private and public sectors in Indonesia. The analysis uses dictator games and real effort tasks to examine wage effects on a measure of motivation that exactly matches the mission of the public sector task. The model and experimental design allow for precisely measuring (1) the distribution of ability over the effort task; (2) the distribution of motivational preferences for public sector missions; and (3) outside options when choosing to work for public sector missions. Three novel conclusions emerge. First, more pro-social workers do, in fact, exert higher effort in a pro-social task. Second, in contrast to previous research, motivated individuals are more likely to join the public sector when public sector pay is low than when it is high. Third, real public sector workers exhibit greater pro-sociality than private sector workers, even for entrants into the Indonesian Ministry of Finance.
  • Publication
    Pro-Social Motivation, Effort and the Call to Public Service
    (Elsevier, 2016-04) Banuri, Sheheryar; Keefer, Philip
    We investigate the interaction of pro-social motivation and wages in pro-social organizations with a novel subject pool, 1700 students destined for the private and public sectors in Indonesia, using a measure of pro-social motivation that exactly matches the mission of the organization. Three novel conclusions emerge. Consistent with a common, but untested, assumption in the theoretical literature, workers with greater pro-social motivation exert higher real effort. However, high pay attracts less pro-socially motivated individuals. Furthermore, we also test whether a real world pro-social organization (the Indonesian Ministry of Finance) attracts pro-socially motivated workers. We find that prospective entrants into the Indonesian Ministry of Finance exhibit higher levels of pro-social motivation than a comparable sample of general workers.
  • Publication
    The use of video vignettes to measure health worker knowledge
    (Elsevier, 2018-09) Banuri, Sheheryar; de Walque, Damien; Keefer, Philip; Haidara, Ousmane Diadie; Robyn, Paul Jacob; Ye, Maurice
    The quality of care is a crucial determinant of good health outcomes, but is difficult to measure. Survey vignettes are a standard approach to measuring medical knowledge among health care providers. Given that written vignettes or knowledge tests may be too removed from clinical practice, particularly where “learning by doing” may be an important form of training, we developed a new type of provider vignette. It uses videos presenting a patient visiting the clinic with maternal/early childhood symptoms. We tested these video vignettes with current and future (students) health professionals in Burkina Faso. Participants indicated that the cases used were interesting, understandable and common. Their performance was consistent with expectations. Participants with greater training (medical doctors vs. nurses and midwives) and experience (health professionals vs. students) performed better. The video vignettes can easily be embedded in computers, tablets and smart phones; they are a convenient tool to measure provider knowledge; and they are cost-effective instruction and testing tools.
  • Publication
    Encouraging Service Delivery to the Poor
    (World Bank, Washington, DC, 2018-12) Banuri, Sheheryar; de Walque, Damien; Keeper, Philip; Robyn, Paul Jacob
    Do service providers respond to pecuniary incentives to serve the poor? Service delivery to the poor is complicated by the extra effort required to deliver services to them and the intrinsic incentives of service providers to exert this effort. Incentive schemes typically fail to account for these complications. A lab-in-the-field experiment with nearly 400 health workers in rural Burkina Faso provides strong evidence that the interaction of effort costs, ability, and intrinsic and extrinsic incentives significantly influences service delivery to the poor. Health workers reviewed video vignettes of medical cases involving poor and nonpoor patients under a variety of bonus schemes. Bonuses to serve the poor have less impact on effort than bonuses to serve the nonpoor; health workers who receive equal bonuses to serve poor and nonpoor patients see fewer poor patients than workers who receive only a flat salary; and bonuses operate largely through their influence on the behavior of pro-poor workers. The paper also presents novel evidence on the selection effects of contract type: pro-poor workers prefer the flat salary contract to the variable salary contract.

Users also downloaded

Showing related downloaded files

  • Publication
    Argentina Country Climate and Development Report
    (World Bank, Washington, DC, 2022-11) World Bank Group
    The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.
  • Publication
    Classroom Assessment to Support Foundational Literacy
    (Washington, DC: World Bank, 2025-03-21) Luna-Bazaldua, Diego; Levin, Victoria; Liberman, Julia; Gala, Priyal Mukesh
    This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.
  • Publication
    Business Ready 2024
    (Washington, DC: World Bank, 2024-10-03) World Bank
    Business Ready (B-READY) is a new World Bank Group corporate flagship report that evaluates the business and investment climate worldwide. It replaces and improves upon the Doing Business project. B-READY provides a comprehensive data set and description of the factors that strengthen the private sector, not only by advancing the interests of individual firms but also by elevating the interests of workers, consumers, potential new enterprises, and the natural environment. This 2024 report introduces a new analytical framework that benchmarks economies based on three pillars: Regulatory Framework, Public Services, and Operational Efficiency. The analysis centers on 10 topics essential for private sector development that correspond to various stages of the life cycle of a firm. The report also offers insights into three cross-cutting themes that are relevant for modern economies: digital adoption, environmental sustainability, and gender. B-READY draws on a robust data collection process that includes specially tailored expert questionnaires and firm-level surveys. The 2024 report, which covers 50 economies, serves as the first in a series that will expand in geographical coverage and refine its methodology over time, supporting reform advocacy, policy guidance, and further analysis and research.
  • Publication
    MIGA Annual Report 2021
    (Washington, DC: Multilateral Investment Guarantee Agency, 2021-10-01) Multilateral Investment Guarantee Agency
    In FY21, MIGA issued 5.2 billion US Dollars in new guarantees across 40 projects. These projects are expected to provide 784,000 people with new or improved electricity service, create over 14,000 jobs, generate over 362 million US Dollars in taxes for the host countries, and enable about 1.3 billion US Dollars in loans to businesses—critical as countries around the world work to keep their economies afloat. Of the 40 projects supported during FY21, 85 percent addressed at least one of the strategic priority areas, namely, IDA-eligible countries (lower-income), fragile and conflict affected situations (FCS), and climate finance. As of June 2021, MIGA has also issued 5.6 billion US Dollars of guarantees through our COVID-19 Response Program and anticipate an expansion to 10–12 billion US Dollars over the coming years, a testament to the countercyclical role that MIGA can play in mobilizing private investment in the face of the pandemic. A member of the World Bank Group, MIGA is committed to strong development impact and promoting projects that are economically, environmentally, and socially sustainable. MIGA helps investors mitigate the risks of restrictions on currency conversion and transfer, breach of contract by governments, expropriation, and war and civil disturbance, as well as offering credit enhancement on sovereign obligations.
  • Publication
    World Development Report 2006
    (Washington, DC, 2005) World Bank
    This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.