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Community Monitoring Yields A Dramatic Drop in Child Mortality: A Uganda Success Story
Detail: Strengthening accountability between citizens and health service providers is often considered critical for improving health care services. Yet how this is to be achieved, and whether it works, remain open questions. Traditional approaches to accountability have tended to be top-down, where someone in the institutional hierarchy of the public sector is assigned to monitor, control and reward/punish agents further down in the hierarchy. In many poor countries, the institutions assigned to monitor providers are typically weak and malfunctioning, and may have few if any incentives to effectively monitor service quality and outcomes. As a complementary strategy, it has therefore been argued that more effort must be placed on strengthening beneficiary control, i.e. strengthening the accountability of providers to citizen-clients.

This paper presents a randomized field experiment on community-based monitoring of public primary health care providers in Uganda. Through two rounds of community meetings, local NGOs encouraged communities to be more involved with the state of health service provision and strengthened their capacity to hold their local health providers accountable for performance. A year after the intervention, treatment communities are more involved in monitoring the provider and health facility staff exert higher effort to serve the community. The paper documents 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.
Date: June 12 2008