Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
This paper presents evidence from 64 in-depth interviews with a sample of urban men who participated in a quantitative study of prospects for increasing medical male circumcision for HIV prevention in Malawi. Despite genuine interest in circumcision, stumbling blocks in the decision-making process deterred men from undergoing the surgery. The high cost of circumcision, including time off from income generation during the recovery period, forced men to choose between circumcision and other responsibilities. Men were often hesitant to give high priority to circumcision because of fear of the surgery. Moreover, men had limited access to accurate information on medical circumcision, which they could have used to allay their fears. Finally, inadequate service provision meant that some men who attempted to get circumcised were turned away by the clinic. Many of these barriers in the decision-making process were especially problematic because medical male circumcision is relatively rare in Malawi.
Country of focus: Malawi.