Leonard, Kenneth L., Melkiory C. Masatu, MD, and Alexandre Vialou. 2007. “Getting Doctors to Do Their Best: The Roles of Ability and Motivation in Health Care Quality.” Journal of Human Resources 42(3): 682–700.
Adherence to medical protocol (quality) is low in most developing countries. We show that, although the differences in knowledge of protocol among doctors in Arusha region of Tanzania are explained by years of training, the differences in actual adherence to protocol and the gap between knowledge and actual adherence are best understood by examining the types of organizations in which these doctors work. These results suggest that some organizations are better at getting doctors to perform at capacity and that understanding the link between organizational structure and protocol adherence is important in any attempt to increase the quality of care.
Kenneth Leonard is a professor of economics at the University of Maryland College Park. Melkiory Masatu is a professor of economics at the Centre for Educational Development in Health, Arusha (CEDHA), Tanzania. Alexandre Vialou is a professor of economics at the University of Maryland College Park. The data used in the article can be obtained beginning January 2008 through December 2010 from Kenneth Leonard, 2200 Symons Hall, College Park, MD 20783, kleonard@arec.umd.edu. This work was funded by NSF Grant 00-95235 and The World Bank, and was completed with the assistance of R. Darabe, M. Kyande, S. Masanja, H. M. Mvungi and J. Msolla. The authors are solely responsible for the data contained herein. We extend our appreciation to the Commission for Science and Technology (COSTECH) for granting permission to perform this research. The paper has benefited from the comments of the audiences at the World Bank and NEUDC and the input of Sonia Lazlo, Ester Duflo and Erik Lichtenberg. The design of the vignettes benefited greatly from extensive discussion with Jishnu Das.