Impact of caregiver incentives on child health: Evidence from an experiment with Anganwadi workers in India

Abstract

This paper tests the effectiveness of performance pay and bonuses among government childcare workers in India. In a controlled study of 160 ICDS centers serving over 4000 children, we randomly assign workers to either fixed bonuses or payments based on the nutritional status of children in their care, and also collect data from a control group receiving only standard salaries. In all three study arms mothers receive nutrition information. We find that performance pay reduces underweight prevalence by about 5 percentage points over 3 months, and height improves by about one centimeter. Impacts on weight continue when incentives are renewed and return to parallel trends thereafter. Fixed bonuses are less expensive but lead to smaller and less precisely estimated effects than performance pay, especially for children near malnutrition thresholds. Both treatments improve worker effort and communication with mothers, who in turn feed a more calorific diet to children at home.