SOCIAL ACCOUNTABILITY AND HEALTHCARE DELIVERY

PROJECT PI's

Manoj Mohanan (Duke), Vikram Rajan (World Bank), Harsha Thirumurthy (UNC)  [Funding: SIEF Global Call # 2]

CO-INVESTIGATORS ON RESEARCH ON SOCIAL NETWORKS & INFORMATION

Arun Chandrasekhar (Stanford) and James Moody (Duke)

BACKGROUND

Increasing the quantity and quality of publicly provided services is widely believed to be essential for improving population level outcomes in health and education.  For example, in countries such as India, the health sector suffers from poor overall performance and high rates of provider absence from work[1],[2] as well as underprovision of nutritional supplements and other health inputs.  Low levels of accountability of public providers towards the communities they serve is theorized to be a key contributor to low quality of public services[3] and poor health outcomes.

Social Accountability (SA) has received considerable global attention as a potential model to improve delivery of services and resulting population outcomes, particularly in health [4],[5],[6],[7]SA encompasses a set of governance interventions aimed at increasing community participation and strengthening community members’ ability to hold service providers accountable at the local level. Two key channels through which SA interventions operate are through:

  1. Provision of information to community members about health outcomes in their community and services to which they are entitled.

  2. Facilitating community engagement with their healthcare providers and local officials, in order to enable grievance redressal. 

Anganwadi Worker preparing hot meal for children.

Photo by Manoj Mohanan

While the information provision aims to address information failures and create greater transparency to raise community members’ demands for better services, the community engagement component aims to enable citizens to channel their complaints (grievance redressal) directly to providers and to make providers more responsive to those complaints[4].  In two studies being conducted in parallel in the state of Uttar Pradesh (Category A & B districts below), this project aims to test the effectiveness of social accountability interventions and unpack the ways in which they may affect health outcomes.

STUDY 1:  

Effect of Information and Faciliation in Social Accountability Interventions

This project has been designed to study mechanisms through which SA interventions may improve community participation and delivery of care. Specifically we study the effect of information relative to the combined effect of information and facilitation. This study is being conducted in 120 villages, randomized to three treatment arms (information only, information plus facilitation, and control). These 120 villages were randomly selected from two districts  -Category A districts - in UP.

 

 In addition, we study the role of information and social networks within these 120 villages, using randomized experiments focusing on:

 

1. Strategies for Information Dissemination 

  • Broadcast messaging to all households via phone v/s 

  • Informing central individuals within the village social network and asking them to spread the information  v/s 

  • Informing Public Officials and asking them to spread the information

 

2. Peer Effects

  • Effect of information within network on individual’s participation in collective action 

  • Effect of participation within network on individual’s participation in collective action

STUDY 2:

Impact of Social Accountability for Public Service Delivery in Rural Health

This study has been designed to test the effectiveness of social accountability (SA) interventions when implemented as a policy instrument “at scale” in Uttar Pradesh (UP), India.  This intervention is implemented in 51 randomly selected blocks spread across 10 districts - Category B districts - in UP (population of over 22 million). 

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This intervention will include information dissemination as well as facilitation of community participation in Village Health, Sanitation and Nutrition Committees (VHSNCs). These activities will be led by Gram Panchayat Coordinators (GPCs), recruited and trained by the State Institute of Rural development (SIRD), with support from the World Bank supported Uttar Pradesh Health Systems Strengthening Project (UPHSSP).

Household-level social network in one of the study villages in UP.

Visualization created by Jim Moody

RESEARCH PAPERS

  • Initial project report expected June 2017

 

 

DOCUMENTATION

[1] Chaudhury, N., J. Hammer, et al. (2006). "Missing in action: teacher and health worker absence in developing countries." Journal of Economic Perspectives 20(1): 91-116

[2] Das, J., A. Holla, et al. (2012). "In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps." Health Affairs (Millwood) 31(12): 2774-2784

[3] World Development Report 2004: Making Service Work for the Poor People. World Bank, Washington, DC

[4] Ringold, D., Holla, A., Koziol, M., & Srinivasan, S. (2012). "Citizens and Service Delivery : Assessing the Use of Social Accountability Approaches in the Human Development Sectors." World Bank Publications, The World Bank, number 2377.

[5] Bjorkman, M. & J. Svensson. (2009). “Power to the People: Evidence from a Randomized Experiment on Community-Based Monitoring in Uganda.” Quarterly Journal of Economics, 124:2: 735–769

[6] Manandhar, D. S., D. Osrin, et al. (2004). "Effect of a participatory intervention with women's groups on birth outcomes in Nepal: cluster-randomised controlled trial." The Lancet 364(9438): 970-979

[7] Tripathy, P., N. Nair, et al. (2010). "Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial." The Lancet 375(9721): 1182-1192.