Timeline for group assignment.

Background
Non-financial incentives are frequently used to improve performance among healthcare providers, capitalizing on mission-driven intrinsic pro-social motivation. However, the effectiveness of incentives varies across settings and may depend on whether they are provided privately or publicly. Using a cluster-randomized controlled trial (ClinicalTrials.gov: NCT05525533) among drug shopkeepers in Tanzania, we designed and evaluated the effectiveness of non-financial incentives in boosting provider performance.
Methods
We developed a non-financial incentive that involved providing shopkeepers with monthly reports of aggregated customer feedback compiled from anonymous surveys from young women (15–24) to appeal to shopkeepers’ pro-social motivation for helping these customers. We randomized whether the feedback was provided privately (via a report) or publicly (displaying certificates of the customer feedback ratings). We estimated linear regression models on provider performance as measured by sales across different categories to young women from administrative point-of sales data over 12 months and estimated whether performance measures were correlated with shopkeepers’ pro-social motivation and concern for social image measured by surveys at Baseline.
Results
Young women customers completed 9,108 anonymous surveys across 99 shops. Shops receiving non-financial incentives privately did not increase performance. However, shops receiving non-financial incentives publicly reported an increase in sales to young women customers (58%, 95% CI: 20%, 97%), most notably for sexual and reproductive health products (96%, 95% CI: 4%, 187%), specifically oral contraception (154%, 95% CI: 9%, 306%) and pregnancy tests (75%, 95% CI: 8%, 143%). Performance measures were correlated with concern for social image but not pro-social motivation at baseline.
Conclusions
Publicly provided non-financial incentives increased performance among drug shopkeepers in Tanzania serving young women. Performance was strongest among those with higher concern for their social image at baseline, rather than those with stronger pro-social motivation. Future interventions using non-financial incentives to motivate healthcare providers should consider leveraging providers’ social image concerns to amplify the effectiveness of incentives.

研究背景
非财务激励常被用于提升医疗服务提供者的绩效，其依托于使命驱动的内在亲社会动机（pro-social motivation）。然而，激励措施的有效性因场景而异，且可能取决于激励是私密提供还是公开公示。本研究依托坦桑尼亚药店店主群体开展整群随机对照试验（cluster-randomized controlled trial，ClinicalTrials.gov: NCT05525533），设计并评估了非财务激励对提升服务提供者绩效的有效性。

研究方法
本研究设计了一款非财务激励方案：向药店店主提供由15至24岁年轻女性匿名调研汇总而成的月度顾客反馈报告，以唤起店主帮助这类群体的亲社会动机。我们将反馈的提供方式随机分为两组：私密组（仅通过报告送达）与公开组（公示顾客反馈评级证书）。本研究基于12个月的销售点（point-of-sales）行政数据，以不同品类商品面向年轻女性的销售额作为绩效衡量指标，构建线性回归模型分析服务提供者绩效；同时通过基线调研数据，分析绩效指标与店主亲社会动机、社会形象关注度的相关性。

研究结果
本次研究共覆盖99家药店，年轻女性顾客累计完成9108份匿名调研。接受私密型非财务激励的药店，其绩效未出现显著提升；而接受公开型非财务激励的药店，面向年轻女性顾客的销售额显著增长（58%，95%置信区间：20%，97%），其中性与生殖健康类商品的销售额增幅最为显著（96%，95%置信区间：4%，187%），具体包括口服避孕药（154%，95%置信区间：9%，306%）与妊娠检测试剂（75%，95%置信区间：8%，143%）。基线调研显示，绩效指标与店主的社会形象关注度呈显著相关，但与亲社会动机无明显关联。

研究结论
公开型非财务激励可提升坦桑尼亚服务年轻女性群体的药店店主绩效。绩效提升最为显著的群体，是基线调研中社会形象关注度更高的店主，而非亲社会动机更强的店主。未来采用非财务激励激励医疗服务提供者的干预研究，应考虑借助服务提供者的社会形象关注度，以放大激励措施的有效性。