Building Resilient Health Systems
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World Bank, Washington, DC
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This paper experimentally examines
efforts aimed at improving health worker performance in the
context of the 2014-15 West African Ebola crisis. Roughly
two years before the outbreak in Sierra Leone, the study
randomly assigned two accountability interventions to
government-run health clinics—one focused on community
monitoring and the other gave status awards to clinic staff.
The findings show that, prior to the Ebola crisis, both
interventions led to improvements in utilization of clinics,
patient satisfaction with the health system, and child
health outcomes. During the crisis, the interventions led to
higher reported Ebola cases, as well as lower mortality from
Ebola, particularly in areas with community monitoring
clinics. The paper explores the potential mechanisms, and
the findings provide evidence consistent with the following
mechanism: by building trust and confidence in health
workers, and improving the perceived quality of care
provided by clinics prior to the outbreak, the interventions
encouraged patients to report and receive treatment. The
results suggest that accountability interventions not only
have the power to improve health systems during normal
times, but also can make health systems resilient to crises
that may emerge over the longer run.
Palabras clave
HEALTH SYSTEM, EBOLA OUTBREAK, HEALTH WORKERS, CLINIC UTILIZATION, PATIENT SATISFACTION, CHILD HEALTH, COMMUNITY MONITORING, STAFF STATUS AWARD, ACCOUNTABILITY