Governance reform, decentralization, and teamwork in public service delivery: Evidence from the Honduran health sector

Public service delivery improves when civil servants work together effectively as teams. While decentralization reforms are common strategies for enhancing the delivery of health services in developing countries, most studies emphasize their effects through rational-choice mechanisms. Fewer studies consider the behavioral implications of decentralization and its potential to improve or hinder the day-to-day work environment for health sector staff. We use an incentivized behavioral game to assess the effectiveness of teamwork among civil servants in decentralized and comparable centrally administered municipal health systems in Honduras. We find that teams from decentralized municipalities are less effective at working together and that this is driven by the adverse effects of the reform among existing staff: new staff pairs are relatively effective, while existing staff do not work as well with each other and in mixed teams. Our findings suggest that policymakers should take measures to help ensure that governance reforms do not undermine the effectiveness of existing staff.

Automated summary

Studies reveal that teams from decentralized municipalities are less effective in working together, mainly due to the adverse effects of the reform on existing staff. While new staff pairs are relatively effective, existing staff do not work as well with each other and in mixed teams. Therefore, policymakers should take measures to ensure that governance reforms do not undermine the effectiveness of existing staff.