81449 enGender Impact: The World Bank’s Gender Impact Evaluation Database Power to the People :Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda Author(s) Martina Bjorkman and Jakob Svensson Contact Martina.Bjorkman.Nyqvist@hhs.se Country Uganda Organizing Theme Voice and Agency, Health Status Completed Intervention Category Community Driven Development Sector Social Development This paper presents a randomized field experiment on community-based monitoring of public primary health care providers in Uganda. Through two rounds of village meetings, localized nongovernmental organizations encouraged communities to be more involved with the state of health service provision and strengthened their capacity to hold their local health providers to account for performance. A year after the intervention, treatment Abstract communities are more involved in monitoring the provider, and the health workers appear to exert higher effort to serve the community. We document large increases in utilization and improved health outcomes—reduced child mortality and increased child weight—that compare favorably to some of the more successful community-based intervention trials reported in the medical literature. Gender Connection Gender Informed Analysis Health of women and girls, sexual, maternal and reproductive health, participation or Gender Outcomes having a voice in community or societal activities, motivation IE Design Clustered Randomized Control Trial (Clustered at health facility level) The goal of the intervention was to strengthen Ugandan health care providers' accountability by using local actors as facilitators. Information on utilization, quality of services and comparisons to other health facilities were assembled in report cards. Report cards were disseminated through a series of meetings that were facilitated by staff from local NGOs. During the meeting, community members were provided information and encouraged to develop views on how to improve delivery and monitoring of health Intervention services. At the end of the meeting, the community's suggestions were summarized in an action plan. To avoid elite capture, the participants included representatives from different spectra of society including young, old, disabled women etc. There was a second meeting where facilitators provided information on service delivery to the health provider's staff. There was an additional meeting where community members met with health workers to discuss suggestions for improvements, and developed a shared action plan. Also, there were follow up meetings after 6 months. Intervention Period The intervention started in 2004 and consisted of a training and a 6 month follow up. In total, approximately 5000 household were surveyed in each round through a stratified Sample population random sample. 88% of households surveyed were included in both the baseline and Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database follow up. The experiment involved 50 dispensaries and health care users, 25 were assigned treatment and 25 served as control. The comparison group received health facility surveys but did not receive report cards or Comparison conditions community-based interventions. Unit of analysis Household level Evaluation Period The follow up survey occurs a year after the intervention. The community based monitoring project increased the quality and quantity of primary health care provision. The program led to a significant increase in the weight of infants by .14 z scores and a significant decrease in child mortality by 33%. Utilization of outpatient Results services was significantly higher (20%) in the treatment group and the overall effect across utilization measures is large and significant. Treatment procedures such as immunization, waiting time, examination procedures and absenteeism significantly improved. Treatment communities became more engaged and began to monitor the health unit more extensively. It is possible there are spillovers from treatment areas to other areas. It is also possible that subdistrict management changed their behavior in response to the intervention. For Primary study limitations example, the treated areas could have been provided additional funding; although there is no evidence this is the case. Bank-Netherlands Partnership Program, World Bank Research Committee, World Bank Funding Source Africa Region division, Swedish International Development Agency, Department for Research Cooperation. Björkman, M., & Svensson, J. (2009). Power to the people: evidence from a randomized Reference(s) field experiment on community-based monitoring in Uganda. The Quarterly Journal of Economics, 124(2), 735-769. Link to Studies http://qje.oxfordjournals.org/content/124/2/735.short Microdata Last updated: 14 August 2013 2