Can Bureaucrats be Paid Like CEOs?
Performance Incentives for Good Child Health in
Rural Chinese Schools’
Renfu Luo, Chinese Academy of Sciences
Grant Miller, Stanford Medical School and NBER
Sean Sylvia, University of Maryland
Scott Rozelle, Freeman Spogli Institute, Stanford University
Marcos Vera-Hernández, University College London
We gratefully acknowledge support from the National Heart, Lung, and Blood
Institute (5R01Hl10602302)
• Behaviour change in developing countries
• Chinese schools
• School principals to take actions to improve
children’s health
• Broader question:
• How can we improve the performance of public
services in developing countries?
• Primary schools are important for both education and health
Public Service Delivery in Developing Countries
 The provision of public services in developing countries is
poor (Banerjee et al. 2004, Das et al 2008, Berendes et al. 2011, Das
et al. 2012)
 Absenteeism rates in primary schools and health centres: 15%-40%
 Prominent explanations:



Lack of skills
Lack of resources
Weak or misaligned incentives
Weak Incentives in Health Delivery: The “Know-Do” Gap
Physician scores on key questions to diagnose and treat
children with diarrhea
Qualities of Stool
Frequency of Stool
Vomiting
Diet and Appetite
Standardized Patient Scores
Vignette Scores
Fever
0
10
20
30
40
50
60
70
Addressing Weak Incentives: Performance Pay
 Usual approach in the private sector: provide monetary
incentives
 Provide incentives for the reduction of anemia
 Will that work in the public sector?
 Concerns about multi-tasking
 Some tasks are difficult to measure, they are difficult to incentive
 Individuals might neglect them in favor of the incentivized ones
 Intrinsically motivated agents (risk of crowding out)
 Bureaucratic mindset: stability, aversion to change
Our distinguishing features
 Study the role of incentives in combination with resources
 The literature does one or the other
 Focus on the monetary value of the incentive rather than other
pieces of information associated with an incentive contract
 We also look at incentives of different sizes
 Focus on higher level public sector workers (“bureaucrats”):
school principals
 Most literature focuses on lower level ones: teachers, nurses, etc.
 Reward health output (anemia rates) rather than inputs
(intake of iron supplements, intake of meat)
 Natural when the incentive is given to someone with decision power
 She can use local knowledge to better achieve the outcome
Outline
1. Anemia in Rural China: Causes,
Consequences and Interventions
2. Model
3. Experimental Design, Data Collection,
Empirical Strategy
4. Results
5. Conclusions
Anemia: Causes and Consequences
 Anemia: Low red blood cell concentration, too little oxygen
to the body
 Most common cause in China: Iron deficiency (accounting
for 85-95%)
 Iron required for hemoglobin, the oxygen-carrying protein in blood
 Anemia is severe form of iron deficiency; iron deficiency 2-3 times more
prevalent
 Consequences: lethargy, fatigue, physical and cognitive
impairment
 Particularly harmful in childhood, detrimental to human capital development
 Inferior educational outcomes among school-aged children (Nokes et al.
1998, Bobonis et al. 2006)
 Anemia affects nearly 25% of school-age children worldwide
 20-60% anemia prevalence among children in rural areas of western China
Hb Concentration and Standardized Exam Scores
Chinese
.5
.5
Math
.4
-.1
0
.1
.2
.3
95% CI
-.5
-.4
Cognitive Score (Normalized)
-.5
-.4
-.3
-.2
-.1
0
.1
.2
.3
95% CI
Adjusted
-.2
Adjusted
Unadjusted
-.3
.4
Unadjusted
60 70 80 90 100110120130140150160170180
Hemoglobin Concentration (g/dL)
60 70 80 90 100110120130140150160170180
Hemoglobin Concentration (g/dL)
Restricted cubic spline estimates, Obs=14,872
Interventions
 How to reduce anemia:
 Fortification of staples (might not be feasible in areas that grow their
own food)
 Iron supplements/multivitamins (might need monitoring, secondary
effects…)
 Increase dietary iron intake




Red meat (heme iron)
Green vegetables (non-heme iron)
Fruits and vegetables high in complementary Vitamin C
Improves iron absorption
Outline
1. Anemia in Rural China: Causes,
Consequences and Interventions
2. Model
3. Experimental Design, Data Collection,
Empirical Strategy
4. Results
5. Conclusions
Model predictions
• The larger the incentive, the more anemia rates will decrease
• An increase in resources will decrease anemia rates
• Incentives are less effective when resources are large
Experimental Design
 All school principals uniformly provided with information about:
 Causes and consequences of anemia
 Known effective strategies to address anemia
 Relationship with academic performance based on peer-reviewed studies
from China
 Block grant: money that the school principal can decide how to
spend within the school.
 Given at the beginning of the experiment.
 Incentive: money for the school principal personal use.
 Given at the end of the experiment.
 The higher the reduction in anemia, the larger the amount of
money will be
Experimental Design
Randomly assignment using a 3×2 design:
No Incentive
Small Incentive
Large Incentive
Small Block Grant
32 schools
20 schools
33 schools
Large Block Grant
33 schools
20 schools
32 schools
 Design: to look at:
 Incentives
 Resources
 and their interaction
 Keeping information and “salience” constant
Block Grants
 Small block grant: 0.3 yuan/student/day (~$0.05)
 Sufficient to purchase multivitamins
 On average, 7,452 yuan/school during the study (~$1,212)
 Large block grant: 0.7 yuan/student/day (~$0.11)
 Sufficient to purchase 60 grams of red meat 3x per week
 On average, 17,388 yuan/school during the study (~$2,829)
 Principals can use grants at their discretion:
 Any strategy to reduce anemia
 Other school functions (e.g. school supplies)
Anemia Reduction Incentives
 A0= number of anemic children at baseline
 A1 = number of anemic children at endline
 Small Incentive= ($2) x ( A0 – A1 )
 Large Incentive = ($20) x ( A0 – A1 )
 They could not lose money
Baseline Balance
Small Grant, No Incentive
Mean
SD
134.191
12.912
2. Anemic (0/1)
0.233
0.423
3. Age (years)
10.713
1.173
4. 5th Grade (0/1)
0.531
0.499
5. Female (0/1)
0.485
0.500
207.094
64.823
7. Has Kitchen (0/1)
0.063
0.246
8. Student-Teacher Ratio
16.228
4.227
62.031
36.695
5.327
11.404
A: Child Characteristics
1. Hemoglobin Concentration
(g/L)
Small
Incentive
Coefficient (standard error) on:
(Small
(Large
Large
Large Grant Incentive)X Incentive)X
Incentive
(Large Grant) (Large Grant)
-0.912
(1.127)
0.024
(0.017)
-0.172
(0.128)
-0.002
(0.006)
0.003
(0.020)
-1.192
(1.009)
0.017
(0.019)
-0.041
(0.111)
0.001
(0.006)
-0.008
(0.017)
0.514
(1.028)
-0.015
(0.018)
-0.030
(0.106)
-0.005
(0.008)
-0.009
(0.019)
0.140
(1.501)
-0.001
(0.024)
0.352*
(0.185)
0.007
(0.011)
0.024
(0.030)
-0.021
(1.476)
0.003
(0.025)
-0.013
(0.144)
0.001
(0.010)
0.010
(0.025)
-1.276
(17.567)
0.141
(0.101)
2.538*
(1.354)
12.218
(13.109)
1.511
(4.112)
3.623
(14.959)
0.074
(0.075)
0.893
(1.210)
-2.281
(11.564)
0.106
(3.006)
-5.396
(16.043)
0.059
(0.083)
-0.286
(1.159)
3.878
(12.945)
0.610
(3.492)
25.344
(25.554)
-0.075
(0.162)
-1.506
(1.911)
-7.346
(21.467)
-0.079
(6.293)
12.357
(20.856)
-0.068
(0.120)
1.064
(1.657)
3.764
(17.794)
-1.611
(5.179)
N
P-value:
Equality
of All
Groups
8398
0.541
8398
0.222
8398
0.379
8398
0.941
8398
0.808
170
0.797
170
0.681
170
0.257
170
0.921
170
0.991
B: School Characteristics
6. Number of Students
9. Time to Furthest Village
Served (mins)
10. Percent Boarding Students
(%)
Sample Contract
Sampling & Randomization
 Sampling frame: Primary schools in 25 officially
designated poor counties in Gansu, Qinghai, and
Shaanxi
Study Sites
Statistical analysis
 Follows a pre-specified plan
 Regression analysis in the sample of children who were
anemic at baseline
 Dependent variable: child’s anemic status at endline
 Key variables:
 Small Incentive, Large Incentive, Large Block Grant,
(Small Incentive)X(Large Grant), (Large Incentive)X(Large Grant)
 P-values corrected for multiple hypothesis testing
Building indices to explore inputs
• Apart from the effect on hemoglobin, we also want
to estimate the effect on behaviors:
• Vitamins intake
• Food intake
• Provision of information to households
• We have several variables measuring each of these
inputs and from several sources (student
questionnaire, household questionnaire…)
• We build indeces to aggregate all these measures
Supplements and Food: indices
 INDEXES:
1. Vitamin Provision
•
•
•
•
•
•
Household received supplements to give to child
School provided supplements to children
Times per week supplements distributed by school
School provided supplements to take home over the weekend
All classmates take supplements
Days given supplements last month
2. Food Provision
•
•
•
•
•
•
Times consumed meat at SCHOOL in past week
Times consumed vegetables at SCHOOL in past week
Times consumed fruit at SCHOOL in past week
Times consumed meat at HOME in past week
Times consumed vegetables at HOME in past week
Times consumed fruit at HOME in past week
Supplements and Food: indices (cont.)
 INDICES
3. Vitamin and Food Provision: combination of (1) and
(2)
4. Information to Households
•
•
•
•
•
•
Number of school-wide parent meetings attended this semester
Number of individual meetings with teacher or principal this
semester
School contacted household about student nutrition this
semester
Household told to give student foods rich in iron
Parent reports knowing of anemia
Parent correctly identifies foods that can prevent anemia (iron
rich foods)
Outline
1. Anemia in Rural China: Causes,
Consequences and Interventions
2. Model
3. Experimental Design, Data Collection,
Empirical Strategy
4. Results
5. Conclusions
Result 1: Large Incentives
Our main question: Do incentives work in this
public sector context with bureaucrats?
Regression adjusted anemia rates at endline
No Incentive
Small Block Grant
36%
Small Incentive
Large Incentive
22.2%
Large Block Grant
Yes! Large incentives cause a statistical significant reduction in the
anemia rate
Result 1: Large incentives
 How do they achieve this reduction in anemia rates?
 Increase intake of iron supplements
 Diet improvements
 We also see that school principals increase
communication with households (and that diet at home
improves)
 Principals seem to want to prevent households from
offsetting behaviors (incentive for outputs?)
Grant Use: no differences
Result 1: Large incentives
 They spent the money in the same way
 So, the better results due to incentives must be due to
higher exerted effort (not only buying the iron supplements,
but making sure they were given to the students).
Result 2: Small incentive
But not any incentive makes the job… The small
incentive is ineffective
Regression adjusted anemia rates at endline
No Incentive
Small Block Grant
36%
Small Incentive
34.8%
Large Incentive
22.2%
Large Block Grant
Difference between the “No Incentive” and “Small Incentive” is
not statistically significant different from zero
The difference between the “Small Incentive” and “Large
Incentive” is statistically different from zero
Result 2: small incentive
 Our results indicate that the size of the incentive
do matter
 Some literature points in the direction that a small incentive
might be enough (Thornton 2008; Banerjee et al. 2010; Karlan et
al. 2011)
 Be careful with comparisons. In our design, the information and
salience of anemia is the same in the “no incentive” than the
“small incentive” arm
Result 2: small incentive
 Although the small incentive is in average not effective,
the is some interesting heterogeneity which is consistent
with crowding-out of pro-social motivation
 The higher the school principal’s pro-sociality, the worst
the anemia rates are of the “Small Incentive” arm
 This is absent in the large incentive group: with the
higher monetary reward the extrinsic motivation
dominates the crowding out of pro-social motivation
even for those school principals with higher prosociality
Result 3: Large block grants
Regression adjusted anemia rates at endline
No Incentive
Small Block Grant
36%
Large Block Grant
21.5%
Small Incentive
34.8%
Large Incentive
22.2%
Larger reductions in anemia are achieved in schools with large
grants vs. those with smaller grants (statistically significant)
Resources do matter!
Grant Use: more money spent on everything
Result 3: Large block grants
 In comparison with the “small grant and no incentive”, the
“large grant and no incentive” achieved:
 Lower anemia rates
 More consumption of iron supplements
 Better diet (but not through households necessarily,
unlike the case with large incentives)
Interaction of incentives and grant size
Regression adjusted anemia rates at endline
No Incentive
Small Incentive
Large Incentive
Small Block Grant
36%
34.8%
22.2%
Large Block Grant
21.5%
16%
27.3%
Sufficiently large incentives are effective at decreasing anemia
when resources are low (small block grant) but they are
ineffective if resources are sufficiently large (large block grant)
In accordance with simple model: if resources are sufficiently
high, the returns of higher effort to reduce anemia further might
be low
Grant Use: more money spent on non-anemia
Comparing large grant and large incentive
Regression adjusted anemia rates at endline
No Incentive
Small Incentive
Large Incentive
Small Block Grant
36%
34.8%
22.2%
Large Block Grant
21.5%
16%
27.3%
They both give the same results… which is cheaper?
Computing the cost of averting one anemia case
Comparing large grant and large incentive
Incremental programatic cost of averting one anemia case (US$)
No Incentive
Large Incentive
Small Block Grant
0
55
Large Block Grant
104
325
Incremental social cost of averting one anemia case (US$)
No Incentive
Large Incentive
Small Block Grant
0
230
Large Block Grant
333
646
Social costs include cost of public funds and costs to households but exclude incentive
payments to school principals
Outline
1. Anemia in Rural China: Causes,
Consequences and Interventions
2. Model
3. Experimental Design, Data Collection,
Empirical Strategy
4. Results
5. Conclusions
Conclusions
 We motivated the paper saying that incentives is an
obvious solution to poor performance but afraid that they
might not work in a public sector context (bureaucrats)
 Well… no much evidence of that…
 In fact, they even went the extra-mile and involved
households in their problem (rewarding outputs)
 And more resources (cash) also works but they are more
expensive (same as Lavy 2002 JPE)
 Incentives end up being effective if resources are
sufficiently high
 No detrimental effect on test scores (not reported here)
Going back to one of the first slides
 Usual approach in the private sector: provide monetary
incentives
 Will that work in the public sector?
 Concerns about multi-tasking

Not reported in this paper, but no detrimental effects on test
scores
 Intrinsically motivated agents (risk of crowding out)
 True but only relevant for small incentives
 Bureaucratic mindset: stability, aversion to change
 Not so important as a priori thought. They even engaged
households.
ADDITIONAL SLIDES
Sampling & Randomization
 170 schools randomly selected for inclusion
 1 school per township
 Stratified randomization to experimental cells using joint
quintiles of:
 Baseline hemoglobin concentration
 Baseline standardized exams scores (Math & Chinese)
Data Collection
 Baseline survey (September 2011)
 Student, Teacher, Principal, School, Household Forms
 Student Hemoglobin (50 randomly selected 4th and 5th graders)
 All students given survey, physical exam
 Endline survey (May 2012)
 4th and 5th grade students only
 Approx. 12,000 total, 8000 with Hb measurements
 Little attrition (6% overall)
 Small imbalance in small incentive cells
Estimation
 Main Specification (for child i in school j located in county c) in
sample of children anemic at baseline:
Yijc=α + T΄jc β + x΄ijϒ + μc + λj + εijc
 Yijc Outcome of interest at endline
 Tjc Vector of treatment dummies and interactions
Small incentive, Large Incentive, Large Block Grant, (Small
Incentive)X(Large Grant), (Large Incentive)X(Large Grant)
 xij
Baseline student, household, school characteristics
 μc
County fixed effects
 λj
Randomization stratum fixed effects
 As specified in the Pre-Analysis Plan
Summary Index Definition (Anderson 2008)
 Weighted mean of several standardized outcomes. The
weights are calculated to maximized the amount of
information captured in the index.
s ij
1

Wij

kK ij
w jk
yijk  y jk
y
 jk
 Where k indexes outcome within dimension j = {vitamin
provision, food consumption, information}. So Kij is the set of
outcomes for observation i in dimension j.
 jky is the standard deviation for outcome k in dimension j
w jk is the outcome weight from the inverted covariance matrix
 Then, the dependent variable is an index of the different
dimension-related outcomes.
Conclusions
 Performance pay for managers can improve service delivery under
some circumstances
 Performance incentives need to be sufficiently strong
 Important evidence of innovation in response to output-based
contracts
 When tied to outputs produced jointly with beneficiaries,
performance pay can create incentives for providers to engage with
beneficiaries in ways that limit compensatory beneficiary responses
 Increasing resources under control of managers can improve
service delivery (specific to our context?)
 Effects on effort, not just budgetary allocation; principals believing
educators are responsible for child health more responsive
 Performance pay for managers and block grants are substitutes
 Some suggestion of ‘multi-tasking’ concerns (little real gain in test
scores), we’re still exploring this
130
125
Predicted Hb Concentration (g/L)
135
Predicted Hemoglobin Concentration
No Incentive
Small Incentive
Small Grant
Large Incentive
Large Grant
Grant Use
Adjustments for multiple testing
• For each outcome variable, we are testing 8 hypotheses
(5 treatment dummies + other composite ones)
• If we test 8 (independent) hypotheses, the probability
that none of them is rejected at 5% when all are true is
(1-0.05)^(8)
• Probability of rejecting at least one at 5% when all
are true is 1-(1-0.05)^(8)=0.34
• We adjust the p-values to keep the probability of
rejecting at least one when all are true (Family Wise
Error Rate) at standard levels of 0.05 or 0.10 (Westfall
and Young, 1993)
Adjustments for multiple testing
• Free step-down resampling method of Westfall and Young
(1993)
• We will be testing 8 hypotheses for our main results
• Run the regression and obtain the standard P-value
(unadjusted P-value)
• Through randomly allocating schools to treatment arms
(permutation) we obtain 8 P-values for each permutation
under the full null hypotheses (permuted P-values)
• We carry out 10,000 permutations
• The adjusted P-value for the hypotheses with the smallest
unadjusted P-value is the percentage of the permutations that
this unadjusted P-value is more than the smallest permuted
P-value
• The adjusted P-value for the hypotheses with the second
smallest unadjusted P-value is the percentage of the
permutations that this unadjusted P-value is more than the
second smallest permuted P-value
Attrition
Dependent Variable: Hemoglobin measurement missing at endline
Children Anemic at
Baseline
(1)
(2)
Full Sample
(3)
(4)
0.016
(0.010)
0.008
(0.009)
0.005
(0.010)
-0.039***
(0.014)
-0.023*
(0.013)
0.014
(0.010)
0.007
(0.009)
0.002
(0.010)
-0.035**
(0.014)
-0.021*
(0.013)
A. Treatments and Interactions
Small Incentive
Large Incentive
Large Grant
(Small Incentive)X(Large Grant)
(Large Incentive)X(Large Grant)
0.014
(0.019)
-0.027
(0.017)
0.010
(0.023)
-0.059*
(0.031)
-0.007
(0.031)
0.017
(0.020)
-0.027
(0.017)
0.009
(0.022)
-0.063**
(0.031)
0.000
(0.031)
Anemia Status
Hemoglobin Concentration
Predicted County-level Anemia Prevalence
Heterogeneity: Any Probability of Promotion in Next Year
(at Baseline)? (Yes = 30%)
Change in Hb Concentration (Relative to comparison) (g/L)
10
8
6
4
2
0
No Incentive
Large Incentive
-2
-4
-6
Small Grant, No
Large Grant, No
Small Grant, Yes
Large Grant, Yes
Did contracts convey additional information?
 Beliefs: Incentives and resources signal task
difficulty (Benabou and Tirole 2003)
 No evidence of this based on subjective expectations
Principal Subjective Expectations (Unadj)
Coefficient (standard error) on:
Mean in Small Grant,
No Incentive Group Small Incentive
A. Immediately after learning of contract
1. Mean of Ex-post Subjective
Distribution
24.710
2. Variance of Ex-post Subjective
Distribution
30.760
B. Endline Survey
3. Mean of Ex-post Subjective
Distribution
18.990
-8.042**
(3.549)
-1.161
(11.328)
Large
Incentive
Large Grant
(Small
Incentive)X
(LargeGrant)
(Large
Incentive)X
(Large Grant)
-3.492
(3.409)
7.858
(12.508)
-2.929
(3.003)
3.008
(9.652)
9.992**
(4.244)
5.979
(16.437)
1.884
(3.956)
-23.370
(18.417)
N
170
170
-3.676
5.084
2.200
-2.346
-6.680
170
(3.934)
(3.931)
(3.572)
(5.762)
(5.339)
4. Variance of Ex-post Subjective
-2.410
-10.208
-13.437
-9.081
17.757
20.570
170
Distribution
(8.002)
(8.785)
(11.239)
(12.716)
(13.376)
NOTES. Data source: authors' survey. Table shows estimations for the effect of incentive contracts and large grants on the distribution of school principal
subjective expectations over anemia reductions. Panel A shows principal subjective expectation at baseline (just after learning of their incentives and budget
amounts) of how many students would be anemic at the end of the school year. Panel B shows results for a similar question at endline that asked principal
expectations for the current anemia rate (before they learned the result). In each case, principals were asked the minimum, maximum and percent probability
above the median. Mean and variance were derived assuming a triangular distribution. Each row shows coefficient estimates (and robust standard errors) from a
seperate regression estimated using equation (1). *, **, and *** indicate significance at 10%, 5% and 1%.
Effects on inputs (using indeces)
Coefficient (standard error) and P-values on:
(Small
Incentiv
Large
e)X
Grant
(Large
Grant)
0.141 0.158 0.242* -0.272
(0.084) (0.081) (0.072) (0.115)
0.241 0.241 0.0522 0.176
A. Children Anemic at Baseline
Mean in Small
Small
Large
Grant, No
Incentive Incentiv Incentiv
e
e
Group
1. Index: Vitamin Provision
-0.050
-0.040
-0.020 0.134 0.198* -0.117 -0.317**
(0.050) (0.050) (0.066) (0.090) (0.090) 1923
0.7892 0.1032 0.0685 0.4888 0.0285
-0.040
0.072 0.145* 0.224** -0.214* -0.302**
(0.054) (0.052) (0.048) (0.078) (0.073) 1923
0.3034 0.0997 0.0045 0.0997 0.0098
-0.120
0.192* 0.191* 0.250** -0.367** -0.261*
(0.072) (0.075) (0.060) (0.099) (0.095) 7920
0.0766 0.0766 0.0067 0.0156 0.0766
-0.020
0.055 0.113* 0.117 -0.099 -0.156
(0.037) (0.040) (0.049) (0.059) (0.070) 7945
0.2781 0.0846 0.1521 0.2781 0.1669
-0.070
0.133** 0.155** 0.193** -0.258** -0.213**
(0.048) (0.050) (0.043) (0.066) (0.067) 7945
0.0324 0.0324 0.0025 0.0095 0.0324
2. Index: Food
3. Index: Vitamin and Food
5. Index: Vitamin Provision
B. Full Sample
(Large
Incentiv
N
e)X
(Large
Grant)
-0.290
(0.106) 1921
0.1226
6. Index: Food
7. Index: Vitamin and Food
Result 1: Large incentives were effective
 working through homes? (remember rewarding outputs not inputs)
Coefficient (standard error) and adjusted P-value on:
Mean in Small Grant,
No Incentive Group
Small Incentive
Large
Incentive
Large
Grant
(Small
Incentive)X
(Large Grant)
(Large
Incentive)X
(Large Grant)
0.134
(0.050)
0.1032
0.192*
(0.065)
0.0808
0.109
(0.062)
0.4179
0.198*
-0.117
-0.317**
(0.066)
(0.090)
(0.090)
0.0685
0.4888
0.0285
0.191
-0.163
-0.297
(0.077)
(0.107)
(0.111)
0.1245
0.3563
0.1118
0.219
-0.103
-0.361*
(0.088)
(0.110)
(0.110)
0.1991
0.5337
0.0572
0.117
-0.099*
-0.156
(0.049)
(0.059)
(0.070)
0.1521
0.2781
0.1669
0.105
-0.105
-0.106
(0.054)
(0.077)
(0.077)
0.259
0.4441
0.4441
0.148
-0.123
-0.223
(0.066)
(0.078)
(0.091)
0.2004
0.3042
0.1626
N
A. Children Anemic at Baseline
2. Index: Food Provision
-0.020
-0.040
(0.050)
0.7892
Index: Food Provision Home
0.079
-0.050
(0.062)
0.3563
Index: Food Provision School
-0.078
-0.040
(0.064)
0.5337
B. Full Sample
8. Index: Food Provision
0.055
-0.020
(0.037)
0.2781
Index: Food Provision Home
0.135*
0.010
(0.049)
0.0914
Index: Food Provision School
0.012
-0.040
(0.051)
0.8454
0.113*
(0.040)
0.0846
0.133*
(0.048)
0.0914
0.113
(0.056)
0.236
1923
1923
1923
7945
7945
7945
Communication with Households (Unadjusted)
More communication with households attributable to large incentives
Mean in Small
Grant, No
Incentive
Group
1. Number of school-wide parent meetings
attended this semester
2. Number of individual meetings with teacher or
principal this semester
3. School contacted household about student
nutrition this semester
1.440
0.870
0.430
4. Household told to give student foods rich in iron
0.270
5. Parent reports knowing of anemia
0.770
6. Parent correctly identifies foods that can prevent
anemia (iron rich foods)
1.770
Coefficient (standard error) on:
Small
Incentive
0.019
(0.207)
0.110
(0.185)
-0.016
(0.077)
0.042
(0.067)
0.055
(0.046)
-0.021
(0.201)
Large
(Small Incentive)X (Large Incentive)X
Large Grant
Incentive
(Large Grant)
(Large Grant)
0.021
(0.198)
0.503**
(0.231)
0.118*
(0.066)
0.115**
(0.055)
-0.044
(0.043)
0.295
(0.236)
0.676***
(0.206)
0.660***
(0.251)
0.062
(0.095)
0.141**
(0.071)
0.017
(0.047)
0.176
(0.236)
-0.978***
(0.301)
-0.735**
(0.325)
-0.062
(0.124)
-0.085
(0.105)
-0.050
(0.069)
-0.018
(0.317)
-0.682**
(0.286)
-0.855**
(0.376)
-0.140
(0.126)
-0.273***
(0.101)
0.037
(0.066)
-0.410
(0.331)
N
1357
1345
1455
1200
1473
1516
0.043
0.139
0.232**
-0.318**
-0.354**
1377
(0.085)
(0.086)
(0.116)
(0.152)
(0.150)
NOTES. Data source: authors' survey. Each row shows coefficient estimates (and robust standard errors) from a separate regression estimated using
equation (1) (controling for baseline hemoglobin concentration, student age, student grade, student sex, number of students in the school, whether
the school has a canteen, student teacher ratio, distance to the furthest village served, percent of boarding students, whether the school has
implemented the "Free Lunch" policy, county dummy variables, and dummy variables for randomization strata). Regressions estimated using only
sample of children anemic (altitude adjusted hemoglobin concentration<120 g/L) at baseline. Dependent variables are shown at left. The final row
shows estimates from a regression with an index summarizing all other variables as the dependent variable. This summary index was computed using
the method discussed in Anderson (2008). *, **, and *** indicate significance at 10%, 5% and 1%.
7. Summary Index
-0.060
Result 2: Small incentives
1. Small Incentive
Children Anemic at Baseline
Full Sample
Hemoglobin
Hemoglobin
Anemic at
Anemic at
Concentration
Concentration
Endline
Endline
(g/L)
(g/L)
-0.387
-0.012
1.054
-0.028
(1.101)
(0.040)
(0.987)
(0.020)
0.792
0.972
0.747
0.587
2. Large Incentive
2.567
(1.044)
0.285
-0.138*
(0.039)
0.064
0.918
(0.946)
0.767
-0.045
(0.022)
0.373
3. Large Grant
4.205**
(1.123)
0.045
-0.145**
(0.038)
0.047
2.872
(0.989)
0.117
-0.073**
(0.021)
0.049
4. (Small Incentive)X(Large Grant)
1.445
(1.541)
0.664
-0.042
(0.056)
0.888
-0.857
(1.340)
0.829
0.027
(0.027)
0.647
5. (Large Incentive)X(Large Grant)
-4.580
(1.586)
0.173
0.196*
(0.058)
0.072
-3.312
(1.404)
0.235
0.086
(0.031)
0.149
1923
129.901
1923
0.364
7945
136.334
7945
0.176
6. Observations
7. Mean in Small Grant, No Incentive Group
Effects on inputs (using indeces)
Coefficient (standard error) and P-values on:
(Small
Incentiv
Large
e)X
Grant
(Large
Grant)
0.141 0.158 0.242* -0.272
(0.084) (0.081) (0.072) (0.115)
0.241 0.241 0.0522 0.176
A. Children Anemic at Baseline
Mean in Small
Small
Large
Grant, No
Incentive Incentiv Incentiv
e
e
Group
1. Index: Vitamin Provision
-0.050
-0.040
-0.020 0.134 0.198* -0.117 -0.317**
(0.050) (0.050) (0.066) (0.090) (0.090) 1923
0.7892 0.1032 0.0685 0.4888 0.0285
-0.040
0.072 0.145* 0.224** -0.214* -0.302**
(0.054) (0.052) (0.048) (0.078) (0.073) 1923
0.3034 0.0997 0.0045 0.0997 0.0098
-0.120
0.192* 0.191* 0.250** -0.367** -0.261*
(0.072) (0.075) (0.060) (0.099) (0.095) 7920
0.0766 0.0766 0.0067 0.0156 0.0766
-0.020
0.055 0.113* 0.117 -0.099 -0.156
(0.037) (0.040) (0.049) (0.059) (0.070) 7945
0.2781 0.0846 0.1521 0.2781 0.1669
-0.070
0.133** 0.155** 0.193** -0.258** -0.213**
(0.048) (0.050) (0.043) (0.066) (0.067) 7945
0.0324 0.0324 0.0025 0.0095 0.0324
2. Index: Food
3. Index: Vitamin and Food
5. Index: Vitamin Provision
B. Full Sample
(Large
Incentiv
N
e)X
(Large
Grant)
-0.290
(0.106) 1921
0.1226
6. Index: Food
7. Index: Vitamin and Food
And the effects of the small and large incentive are
statistically different
Children Anemic at Baseline
Full Sample
Hemoglobin
Concentration
(g/L)
Anemic at
Endline
Hemoglobin
Concentration
(g/L)
Anemic at
Endline
Large vs. Small Incentive
0.285
0.089
0.908
0.647
Large Incentive vs. Large Grant
0.597
0.972
0.301
0.587
Large Incentive + (Large
Incentive)X(Large Grant)
0.511
0.650
0.209
0.373
9. Additional Hypotheses: Adjusted
p-values
Crowding-out of pro-social / intrinsic motivation
Dependent Vble: Anemic at follow-up
VBLE
VBLEx(Small
Incentive)
VBLEx(Large VBLEx(Large
Incentive)
Grant)
VBLEx(Small VBLEx(Large
Incentive)X
Incentive)X
(Large Grant) (Large Grant)
-0.148
-0.043
(0.093)
(0.075)
0.58
0.94
VBLE=Prosocial Motivation Index
0.230
(0.070)
0.09
-0.003
(0.047)
0.95
0.021
(0.046)
0.94
VBLE=(Prosocial Motivation
Index>Median)
0.310
(0.079)
0.04
0.061
(0.093)
0.63
0.156
(0.085)
0.4
-0.291
(0.117)
0.25
-0.200
(0.123)
0.4
VBLE=Intrinsic Motivation Index
0.104
(0.040)
0.24
-0.010
(0.051)
0.98
-0.014
(0.042)
0.98
-0.102
(0.056)
0.51
-0.016
(0.061)
0.98
VBLE=(Intrinsic Motivation
Index>Median)
0.092
(0.083)
0.6
-0.043
(0.091)
0.98
-0.092
(0.076)
0.98
0.093
(0.128)
0.98
0.032
(0.119)
0.98
So, there is some evidence of prosocial/intrinsic motivation
Result 3: Large grants
1. Small Incentive
Children Anemic at Baseline
Full Sample
Hemoglobin
Hemoglobin
Anemic at
Anemic at
Concentration
Concentration
Endline
Endline
(g/L)
(g/L)
-0.387
-0.012
1.054
-0.028
(1.101)
(0.040)
(0.987)
(0.020)
0.792
0.972
0.747
0.587
2. Large Incentive
2.567
(1.044)
0.285
-0.138*
(0.039)
0.064
0.918
(0.946)
0.767
-0.045
(0.022)
0.373
3. Large Grant
4.205**
(1.123)
0.045
-0.145**
(0.038)
0.047
2.872
(0.989)
0.117
-0.073**
(0.021)
0.049
4. (Small Incentive)X(Large Grant)
1.445
(1.541)
0.664
-0.042
(0.056)
0.888
-0.857
(1.340)
0.829
0.027
(0.027)
0.647
5. (Large Incentive)X(Large Grant)
-4.580
(1.586)
0.173
0.196*
(0.058)
0.072
-3.312
(1.404)
0.235
0.086
(0.031)
0.149
1923
129.901
1923
0.364
7945
136.334
7945
0.176
6. Observations
7. Mean in Small Grant, No Incentive Group
Effects on inputs (using indeces)
Coefficient (standard error) and P-values on:
(Small
Incentiv
Large
e)X
Grant
(Large
Grant)
0.141 0.158 0.242* -0.272
(0.084) (0.081) (0.072) (0.115)
0.241 0.241 0.0522 0.176
A. Children Anemic at Baseline
Mean in Small
Small
Large
Grant, No
Incentive Incentiv Incentiv
e
e
Group
1. Index: Vitamin Provision
-0.050
-0.040
-0.020 0.134 0.198* -0.117 -0.317**
(0.050) (0.050) (0.066) (0.090) (0.090) 1923
0.7892 0.1032 0.0685 0.4888 0.0285
-0.040
0.072 0.145* 0.224** -0.214* -0.302**
(0.054) (0.052) (0.048) (0.078) (0.073) 1923
0.3034 0.0997 0.0045 0.0997 0.0098
-0.120
0.192* 0.191* 0.250** -0.367** -0.261*
(0.072) (0.075) (0.060) (0.099) (0.095) 7920
0.0766 0.0766 0.0067 0.0156 0.0766
-0.020
0.055 0.113* 0.117 -0.099 -0.156
(0.037) (0.040) (0.049) (0.059) (0.070) 7945
0.2781 0.0846 0.1521 0.2781 0.1669
-0.070
0.133** 0.155** 0.193** -0.258** -0.213**
(0.048) (0.050) (0.043) (0.066) (0.067) 7945
0.0324 0.0324 0.0025 0.0095 0.0324
2. Index: Food
3. Index: Vitamin and Food
5. Index: Vitamin Provision
B. Full Sample
(Large
Incentiv
N
e)X
(Large
Grant)
-0.290
(0.106) 1921
0.1226
6. Index: Food
7. Index: Vitamin and Food
Result 3: Large grant
 Some tendency towards working more through the school than the home
Coefficient (standard error) and adjusted P-value on:
Mean in Small Grant,
No Incentive Group
Small Incentive
Large
Incentive
Large
Grant
0.134
(0.050)
0.1032
0.192*
(0.065)
0.0808
0.109
(0.062)
0.4179
0.198*
(0.066)
0.0685
0.191
(0.077)
0.1245
0.219
(0.088)
0.1991
0.113*
(0.040)
0.0846
0.133*
(0.048)
0.0914
0.113
(0.056)
0.236
0.117
(0.049)
0.1521
0.105
(0.054)
0.259
0.148
(0.066)
0.2004
(Small
Incentive)X
(Large Grant)
(Large
Incentive)X
(Large Grant)
N
A. Children Anemic at Baseline
2. Index: Food Provision
-0.020
-0.040
(0.050)
0.7892
Index: Food Provision Home
0.079
-0.050
(0.062)
0.3563
Index: Food Provision School
-0.078
-0.040
(0.064)
0.5337
B. Full Sample
8. Index: Food Provision
0.055
-0.020
(0.037)
0.2781
Index: Food Provision Home
0.135*
0.010
(0.049)
0.0914
Index: Food Provision School
0.012
-0.040
(0.051)
0.8454
-0.117
-0.317**
(0.090)
(0.090)
0.4888
0.0285
-0.163
-0.297
(0.107)
(0.111)
0.3563
0.1118
-0.103
-0.361*
(0.110)
(0.110)
0.5337
0.0572
-0.099*
-0.156
(0.059)
(0.070)
0.2781
0.1669
-0.105
-0.106
(0.077)
(0.077)
0.4441
0.4441
-0.123
-0.223
(0.078)
(0.091)
0.3042
0.1626
1923
1923
1923
7945
7945
7945
Result 4: Substitution
1. Small Incentive
Children Anemic at Baseline
Full Sample
Hemoglobin
Hemoglobin
Anemic at
Anemic at
Concentration
Concentration
Endline
Endline
(g/L)
(g/L)
-0.387
-0.012
1.054
-0.028
(1.101)
(0.040)
(0.987)
(0.020)
0.792
0.972
0.747
0.587
2. Large Incentive
2.567
(1.044)
0.285
-0.138*
(0.039)
0.064
0.918
(0.946)
0.767
-0.045
(0.022)
0.373
3. Large Grant
4.205**
(1.123)
0.045
-0.145**
(0.038)
0.047
2.872
(0.989)
0.117
-0.073**
(0.021)
0.049
4. (Small Incentive)X(Large Grant)
1.445
(1.541)
0.664
-0.042
(0.056)
0.888
-0.857
(1.340)
0.829
0.027
(0.027)
0.647
5. (Large Incentive)X(Large Grant)
-4.580
(1.586)
0.173
0.196*
(0.058)
0.072
-3.312
(1.404)
0.235
0.086
(0.031)
0.149
6. Observations
7. Mean in Small Grant, No Incentive Group
1923
129.901
1923
0.364
7945
136.334
7945
0.176
Coefficient (standard error) and P-values on:
A. Children Anemic at Baseline
Mean in Small
Grant, No
Incentive Group
1. Index: Vitamin
Provision
5. Index: Vitamin
Provision
B. Full Sample
Small
Incentive
Large
Incentive
Large
Grant
-0.050
0.141
(0.084)
0.241
0.158
(0.081)
0.241
0.242*
(0.072)
0.0522
-0.040
-0.020
(0.050)
0.7892
0.134
(0.050)
0.1032
0.198*
(0.066)
0.0685
-0.117
(0.090)
0.4888
-0.317**
(0.090)
0.0285
-0.040
0.072
(0.054)
0.3034
0.145*
(0.052)
0.0997
0.224**
(0.048)
0.0045
-0.214*
(0.078)
0.0997
-0.302**
(0.073)
0.0098
-0.120
0.192*
(0.072)
0.0766
0.191*
(0.075)
0.0766
0.250**
(0.060)
0.0067
-0.367**
(0.099)
0.0156
-0.261*
(0.095)
0.0766
-0.020
0.055
(0.037)
0.2781
0.113*
(0.040)
0.0846
0.117
(0.049)
0.1521
-0.099
(0.059)
0.2781
-0.156
(0.070)
0.1669
-0.070
0.133**
(0.048)
0.0324
0.155**
(0.050)
0.0324
0.193**
(0.043)
0.0025
-0.258**
(0.066)
0.0095
-0.213**
(0.067)
0.0324
2. Index: Food
3. Index: Vitamin and
Food
6. Index: Food
7. Index: Vitamin and
Food
(Large
(Small
Incentive)X
Incentive)X
(Large
(Large Grant)
Grant)
-0.272
-0.290
(0.115)
(0.106)
0.176
0.1226
Result 4: Substitution
 This substitution is so large that it takes us to test whether
the effect of large incentives are detrimental when
principals are also given a large grant
Children Anemic at Baseline
Full Sample
Hemoglobin
Concentration (g/L)
Anemic at
Endline
Hemoglobin
Concentration
(g/L)
Anemic at
Endline
Large vs. Small Incentive
0.285
0.089
0.908
0.647
Large Incentive vs. Large Grant
0.597
0.972
0.301
0.587
Large Incentive + (Large
Incentive)X(Large Grant) = 0
0.511
0.650
0.209
0.373
9. Additional Hypotheses: Adjusted pvalues
Regression adjusted anemia rates at endline
No Incentive
Small Incentive
Large Incentive
Small Block Grant
36%
34.8%
22.2%
Large Block Grant
21.5%
16%
27.3%