We assess the effectiveness of accountability systems relying on patient reporting in the Kenyan
health sector. We evaluate patients’ willingness to file complaints on service providers, and
providers’ responsiveness to the possibility of receiving such complaints. We contrast reporting
systems where complaints have no direct consequences on providers, such as standard complaint
boxes, and reporting systems where complaints lead to either monetary penalties or non-monetary
consequences in the form of peer shaming. We employ a specially designed laboratory-in-the-field
experiment involving randomly selected providers and patients from public and private health
centers in Nairobi. Combining the experimental variation with non-experimental variation in
provider and client characteristics such as sector of work and the existence of personal
relationships between clients and providers, we find that: 1) disclosing patients’ complaints to
providers’ professional peers is at least as effective as imposing monetary penalties based on
patients’ complaints; 2) the possibility of retaliation against patients does not reduce the
effectiveness of reporting systems relying on peer shaming; 3) associating tangible consequences
with complaints slightly lowers patients’ willingness to file such complaints, mainly due to the
existence of personal relationships with providers. Overall, our findings support the
implementation of citizen reporting systems that leverage peer pressure and reputational concerns.