Seminar Papers, Institute for International Economic Studies, Stockholm University
No 749:
Local Accountability
Martina Björkman ()
, Ritva Reinikka ()
and Jakob Svensson ()
Abstract: Identifying and implementing incentives that give rise to
a strong relationship of accountability between service providers and
beneficiaries is viewed by many as critical for improving service delivery.
How to achieve this in practice and if it at all works, however, remain
open questions. Systematic evaluation of service delivery innovations to
increase accountability can show what works, what doesn’t and why, a first
step to scaling up success. This paper discusses one such attempt: a
randomized evaluation of a Citizen Report Card project at the community
level in primary health care in Uganda. The Citizen Report Card project
collected quantitative information on the quality and quantity of health
service provision from citizens and public health care providers. This
information were then assembled in "easy access" report cards that were
disseminated, together with practical information on how best to use this
information, in community, staff, and interface meetings by local community
organizations in order to enhance citizens’ ability to monitor the health
care providers. The intervention improved both the quality and quantity of
health service provision in the treatment communities: One year into the
program, average utilization was 16 percent higher in the treatment
communities; the weight of infants higher, and the number of deaths among
children under-five markedly lower. Treatment communities became more
extensively involved in monitoring providers following the intervention,
but we find no evidence of increased government funding. These results
suggest that the improvements in the quality and quantity of health service
delivery resulted from increased effort by the health unit staff to serve
the community.
Keywords: Accountability; Incentives; Health Care; Uganda; (follow links to similar papers)
JEL-Codes: I18; O12; (follow links to similar papers)
33 pages, November 22, 2006
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