Power to the People Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda

1. Power to the PeopleEvidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda Martina Bj�rkman, IGIER, University of Bocconi, & CEPR Jakob Svensson, IIES, Stockholm University, NHH, & CEPR

2. Background Millions of children die from easily preventable causes Weak incentives for service providers Top-down approach to monitoring also lacks appropriate incentives Recent focus on strengthening providers� accountability to citizen-clients Beneficiaries lack information Inadequate participation by beneficiaries

3. Research Questions Can an intervention that facilitates community-based monitoring lead to increased quantity of health care? Increased quality of health care? Did the intervention increase treatment communities� ability to exercise accountability? Did the intervention result in behavioral changes of staff?

4. Intervention 50 rural dispensaries in Uganda Drawn from 9 districts Households w/in 5 km catchment area 18 local NGOs Provide communities with information on relative performance Encourage beneficiaries to develop a plan that identified steps the provider and community should take to improve service performance and ways to get the community more actively involved in monitoring

5. Intervention Specifics Pre-intervention survey data used to compile unique �report card� for each facility Translated into community�s main language Posters by local artist for non-literate Information provided to community through participatory / interactive meetings Community: suggestions summarized in action plan Staff: review & analyze performance Interface: contract outlining what needed to be done, how, and by whom

6. Timing Intervention intended to �kick-start� community monitoring Mid-term review after 6 months, but no other outside presence in communities Not able to document all actions taken by communities