Experimental Evidence on the Long-Run Impact of Community-Based Monitoring

Martina Björkman Nyqvist, Damien de Walque, Jakob Svensson
2017 American Economic Journal: Applied Economics  
This paper presents the results of two field experiments on local accountability in primary health care in Uganda. Efforts to stimulate beneficiary control, coupled with the provision of report cards on staff performance, resulted in significant improvements in health care delivery and health outcomes in both the short and the longer run. Efforts to stimulate beneficiary control without providing information on performance had no impact on quality of care or health outcomes. The paper shows
more » ... The paper shows that informed users are more likely to identify and challenge (mis)behavior by providers and as a result turn their focus to issues that they can manage locally. Notes: In each panel and row we report an average standardized pretreatment effect (see text for details). Robust standard errors are reported in parentheses. Column (i) corresponds to the 2004 baseline data for the Participation and Information Experiment and column (ii) uses 2006 baseline data for the Participation Experiment. Description of variables: Utilization from health facility records summarizes outpatients and deliveries. Utilization pattern of the users summarizes seven measures including use of the project facility, an NGO facility, a private-for-profit facility, other government facility, another provider, a traditional healer and self-treatment, reversing sign of traditional healer and self-treatment. Quality of services according to users summarizes the use of any equipment during the visit and waiting time, reversing sign of waiting time. Catchment area statistics summarizes the number of households in the catchment area, the number of households per village, and the distance from the villages to the health facility. Health facility characteristics uses different data in columns (i) and (ii) because of differences in data collected at the time of each baseline survey. For column (i) it summarize ten measures about the presence of piped water, access to a radio, a newspaper, the existence of a separate maternity unit, the distance to the nearest Local Council I and to the nearest public health provider, number of staff with advanced A-level education and with less than A-level education, drank safely today and days without electricity, reversing sign of days without electricity and distance to nearest local council. For column (ii) it summarizes six measures about the presence of piped water, working water source, functioning electricity, yellow star certification of the health facility, number of staff with advanced A-level education and with less than A-level education. Citizen perceptions of treatment summarize four measures about politeness, attention, freedom to express themselves and information about drug deliveries. Supply of drugs summarizes five measures about the availability of erythromycin, chloroquine, septrine, quinine and mebendazole. User charges summarize four measures about the existence of user charges for drugs, general treatment, injections and deliveries, reversing all signs.
doi:10.1257/app.20150027 fatcat:373uo7oeynfrxlush5y25rqsou