Power to the People : Evidence from a Randomized Field Experiment of a Community-Based Monitoring Project in Uganda
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World Bank, Washington, DC
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This paper analyzes the importance of
strengthening the relationship of accountability between
health service providers and citizens for improving access
to and quality of health care. How this is to be achieved,
and whether it works, however, remain open questions. The
paper presents a randomized field experiment on increasing
community-based monitoring. As communities began to more
extensively monitor the provider, both the quality and
quantity of health service provision improved. One year into
the program, there are large increases in utilization,
significant weight-for-age z-score gains of infants, and
markedly lower deaths among children. The findings on staff
behavior suggest that the improvements in quality and
quantity of health service delivery resulted from an
increased effort by the staff to serve the community.
Overall, the results suggest that community monitoring can
play an important role in improving service delivery when
traditional top-down supervision is ineffective.
Palabras clave
AGGREGATE OUTCOMES, ANTENATAL CARE, CAPITATION, CHILD DEATHS, CLINICS, COMMUNITIES, COMMUNITY PARTICIPATION, DELIVERY SYSTEM, DIARRHEA, DISEASES, DISPENSARIES, DISTRICTS, DRINKING WATER, ENGINEERS, EXPENDITURES, EXTERNALITIES, FAMILY PLANNING, HEALTH, HEALTH CARE, HEALTH CARE DELIVERY, HEALTH CARE PROVIDERS, HEALTH CARE PROVISION, HEALTH CARE SYSTEM, HEALTH CENTERS, HEALTH CLINICS, HEALTH EDUCATION, HEALTH FACILITIES, HEALTH INDICATORS, HEALTH OUTCOMES, HEALTH PROVISION, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICES, HEALTH SYSTEM, HEALTH WORKERS, HOSPITALS, HOUSEHOLDS, IMMUNIZATION, INFANTS, INFECTION, INTERVENTION, LABORATORY SERVICES, MALARIA, MEDICAL CARE, MORTALITY, NURSES, NURSING, ORAL REHYDRATION, ORAL REHYDRATION THERAPY, ORT, OUTPATIENT CARE, OUTPATIENT SERVICES, PATIENT, PATIENTS, PLANNING, PNEUMONIA, POLICY RESEARCH, POSTERS, PRIMARY HEALTH CARE, PRIMARY SCHOOLS, PROBABILITY, PROVIDER INCENTIVES, PUBLIC HEALTH, PUBLIC HEALTH SERVICES, PUBLIC SECTOR, QUALITY OF HEALTH CARE, REHABILITATION, RURAL AREAS, SOCIAL DEVELOPMENT, SOCIAL SANCTIONS, TREATMENT, VILLAGES, WORKERS