90353 enGender Impact: The World Bank’s Gender Impact Evaluation Database Does Involvement of Local NGOs Enhance Public Service Delivery? Cautionary Evidence from a Malaria-Prevention Evaluation in India Author(s) Ashis Das, Jed Friedman, Eeshani Kandpal Contact ekandpal@worldbank.org Country India Organizing Theme Women's Health Status Completed Intervention Category Information Campaign, Supervision, Malaria control Sector Health, Nutrition & Population Using data from an experimental supportive intervention to India's malaria control program, this paper studies the impact of leveraging local non-state capacity to promote mosquito net usage and recommended fever care-seeking patterns. The supportive activities were conducted simultaneously by three nongovernmental organizations in two endemic districts in the state of Orissa. The study finds that program impact varied significantly by location. Examining three potential sources Abstract of this variation (differential population characteristics, differential health worker characteristics, and differential implementer characteristics), the analysis provides evidence that both population and nongovernmental organization characteristics significantly affected the success of the program. The paper discusses these findings as they relate to the external validity of development policy evaluations and, specifically, for the ability of the health system to benefit from limited non-state capacity in under-resourced areas. Gender Connection Gender Informed Analysis The usage of long-lasting insecticide treated nets by pregnant women, prompt Gender Outcomes treatment by skilled providers in cases of fever IE Design Clustered Randomized Controlled Trial The first intervention group received community mobilization activities and intensive supervision of community health workers, called ASHA, in addition to the long-lasting insecticide treated nets (LLINs) distributed to every study village as part Intervention of the new national control program; the second intervention group received community mobilization activities but without the intensive individual supervision of ASHA. Intervention Period 2010 A total of 120 endemic villages, with an average population of approximately 900 from four sub-districts of Sundargarh and Mayurbhanj districts, both of which are Sample population on the national list of 50 highly malaria endemic districts identi ed by the Indian government. Comparison The control arm (referred to as arm K) received the routine activities of the conditions government's malaria control program, i.e. fever case management by ASHAs Last updated: 2 September 2014 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database without any additional supervision or community mobilization. Unit of analysis Individual level Evaluation Period 2010-2011 Overall, we find the interventions, particularly the one with supportive supervision of ASHA, improved care-seeking behavior, ASHA motivation and job satisfaction, and gains in population LLIN usage. However, we also observe considerable divergence in the outcomes between the two districts in our sample. In Mayurbhanj district, the intervention increased net usage from an already high baseline level, particularly for the most vulnerable subpopulations of children under five and pregnant women, as well as dramatically increased the rates at which fever cases Results promptly seek care from ASHA. In Sundargarh district, however, the intervention had little effect, whether on net usage, care-seeking behavior, fever incidence, or health worker motivation. There are various possible reasons that account for the observed divergence across districts. The characteristics of the population diverge in some key dimensions such as caste, religion, and possibly household wealth. In addition, the MGOs that satisfied the selection criteria in each distric have vastly different characteristics that may have impacted implementation. Primary study limitations Strategic Impact Evaluation Trust Fund and the Knowledge for Change for Funding Source Program Das, A., Friedman, J. & Kandpal, E. (2014). Does Involvement of Local NGOs Reference(s) Enhance Public Service Delivery? Cautionary Evidence from a Malaria-Prevention Evaluation in India. World Bank Policy Research Working Paper No 6931 Link to Studies http://www- wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2014/06/19/ 000158349_20140619085232/Rendered/PDF/WPS6931.pdf Microdata Last updated: 2 September 2014 2