Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda*
Abstract
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 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.
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Interventions might also have indirect effects such as improved public integrity, improved quality or quantity of specific public services.
“We are aware that, besides more direct impacts such as the reduction in the level of specific forms of corruption, interventions might also have indirect effects such as improved public integrity, improved quality or quantity of specific public services (Banerjee et al., 2010; Björkman & Svensson, 2009).”
From Public sector reforms and their impact on the level of corruption: A systematic review (2021) · cites this paper as Björkman & Svensson, 2009
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Gaitonde, R., Oxman, A. D., Okebukola, P. O., & Rada, G. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008856.pub2 · Cited by 117 · see citing works
Interventions to promote social cohesion in sub-Saharan Africa
King, E., Samii, C., & Snilstveit, B. (2010) · Journal of Development Effectiveness · doi:10.1080/17449057.2010.504552 · Cited by 117 · see citing works
“…criteria (Dovey and Onyx 2001, Rono and Aboud 2003, Cousins and Kepe 2004, Moore and Cissé 2005, Okot et al. 2005, Lemanski 2006, Babatunde and Setiloane 2007, Bolton et al. 2007, Bjorkman and Svensson 2007, Lesko 2007), leaving us with eight included studies reviewing a total of 10 interventions.”
Corruption, investments and contributions to public goods: Experimental evidence from rural Liberia
Beekman, G., Bulte, E., & Nillesen, E. (2014) · Journal of Public Economics · doi:10.1016/j.jpubeco.2014.04.004 · Cited by 116 · see citing works
The future of routine immunization in the developing world: challenges and opportunities
Shen, A. K., Fields, R., & McQuestion, M. (2014) · Global Health: Science and Practice Journal · doi:10.9745/ghsp-d-14-00137 · Cited by 115 · see citing works
International Interventions to Build Social Capital: Evidence from a Field Experiment in Sudan
Avdeenko, A., & Gilligan, M. (2015) · American Political Science Review · doi:10.1017/s0003055415000210 · Cited by 89 · see citing works
Linking Local Government Discretion and Accountability in Decentralisation
Yilmaz, S., Beris, Y., & Serrano-Berthet, R. (2010) · doi:10.1111/j.1467-7679.2010.00484.x · Cited by 111
Field Experiments and the Political Economy of Development
Humphreys, M., & Weinstein, J. M. (2009) · Annual Review of Political Science · doi:10.1146/annurev.polisci.12.060107.155922 · Cited by 111 · see citing works
Endogenous Participation: Strengthening Prior Consultation in Extractive Economies
Falleti, T., & Riofrancos, T. N. (2018) · World Politics · doi:10.1017/s004388711700020x · Cited by 109 · see citing works
Ciccone, D. K., Vian, T., Maurer, L., & Bradley, E. H. (2014) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2014.07.010 · Cited by 105 · see citing works
Galperin, H., & Viecens, M. F. (2017) · Development Policy Review · doi:10.1111/dpr.12210 · Cited by 104 · see citing works
“In a similar study, Bjorkman and Svensson (2009) document how providing local communities in Uganda with basic information about the quality of health services received (in comparison to other communities and with the standards set by the federal government) reduced capture and led to increases in both the quality and…”
Fink, G., McConnell, M. A., & Vollmer, S. J. (2014) · Journal of Development Effectiveness · doi:10.1080/19439342.2013.875054 · Cited by 104 · see citing works
It's All about MeE: Using Structured Experiential Learning ("e") to Crawl the Design SpacePreprint
Pritchett, L., Samji, S., & Hammer, J. S. (2013) · SSRN Electronic Journal · doi:10.2139/ssrn.2248785 · Cited by 104 · see citing works
District decision-making for health in low-income settings: a systematic literature review
Wickremasinghe, D., Hashmi, I., Schellenberg, J., & Avan, B. (2016) · Health Policy and Planning · doi:10.1093/heapol/czv124 · Cited by 102 · see citing works
Bjorkman, M., & Svensson, J. (2010) · Journal of the European Economic Association · doi:10.1111/j.1542-4774.2010.tb00527.x · Cited by 100 · see citing works
Self-citationDettrick, Z., Firth, S. M., & Soto, E. J. (2013) · PLoS ONE · doi:10.1371/journal.pone.0083070 · Cited by 98 · see citing works
Accountability, Participation and Foreign Aid Effectiveness
Winters, M. S. (2010) · doi:10.1111/j.1468-2486.2010.00929.x · Cited by 98
Kruks-Wisner, G. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108185899 · Cited by 97 · see citing works
Sheely, R. (2015) · World Development · doi:10.1016/j.worlddev.2014.10.024 · Cited by 95 · see citing works
Declaring and Diagnosing Research Designs
Blair, G., Cooper, J., Coppock, A., & Humphreys, M. (2019) · American Political Science Review · doi:10.1017/s0003055419000194 · Cited by 101 · see citing works
Why Worry About the Politics of Childhood Undernutrition
Nisbett, N., Gillespie, S., Haddad, L., & Harris, J. (2014) · World Development · doi:10.1016/j.worlddev.2014.06.018 · Cited by 93 · see citing works
Roder-DeWan, S., Gage, A., Hirschhorn, L., Twum-Danso, N., Liljestrand, J., Asante-Shongwe, K., Rodríguez, V., Yahya, T., & Kruk, M. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002879 · Cited by 88 · see citing works
“It has also been shown to drive decisions about care seeking [63].”
The Rise and Fall of Local Elections in China
Martinez-Bravo, M., Miquel, G. P., Qian, N., & Yao, Y. (2022) · The American Economic Review · doi:10.1257/aer.20181249 · Cited by 85 · see citing works
“…number of empirical studies on re-election incentives (e.g., Dal-Bó and Rossi, 2011; de Janvry et al., 2010; Ferraz and Finan, 2011) and on the effect of information on electoral accountability (e.g., Besley monitoring village leaders is reminiscent to the findings of Björkman and Svensson (2009).”
Xu, Y. (2018) · Journal of Banking & Finance · doi:10.1016/j.jbankfin.2018.05.008 · Cited by 89 · see citing works
Persson, L. Å., Nga, N. T., Målqvist, M., Thi Phuong Hoa, D., Eriksson, L., Wallin, L., Selling, K., Huy, T. Q., Duc, D. M., Tiep, T. V., et al. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001445 · Cited by 83 · see citing works
“A participatory community-based intervention in Uganda that was informed by local health data was also effective in reducing infant mortality [14].”
Danhoundo, G., Nasiri, K., & Wiktorowicz, M. (2018) · BMC Public Health · doi:10.1186/s12889-018-5407-8 · Cited by 83
Do Local Elections in Non-Democracies Increase Accountability? Evidence from Rural China
Martinez-Bravo, M., Miquel, G. P., Qian, N., & Yao, Y. (2011) · doi:10.3386/w16948 · Cited by 82
Waddington, H. S., Sonnenfeld, A., Finetti, J., Gaarder, M. M., John, D., & Stevenson, J. (2019) · Campbell Systematic Reviews · doi:10.1002/cl2.1025 · Cited by 106 · see citing works
Working with the Grain and Swimming against the Tide
Booth, D. (2012) · Public Management Review · doi:10.1080/14719037.2012.657959 · Cited by 80 · see citing works
“A subsequent piece of work involving some of the same researchers (Björkman and Svensson 2007) is increasingly being cited in the blogosphere in support of the idea that citizen pressure stimulated by release of information is a likely road to service improvement.”
InfluentialHeckle and Chide: Results of a Randomized Road Safety Intervention in Kenya
Habyarimana, J., & Jack, W. (2011) · Journal of Public Economics · doi:10.1016/j.jpubeco.2011.06.008 · Cited by 80 · see citing works
Pieterse, P., & Lodge, T. (2015) · International Health · doi:10.1093/inthealth/ihv024 · Cited by 79 · see citing works
English, M., Nzinga, J., Mbindyo, P., Ayieko, P., Irimu, G., & Mbaabu, L. (2011) · Implementation science : IS · doi:10.1186/1748-5908-6-124 · Cited by 79 · see citing works
“Previous work on changing healthcare provider behaviours or performance in low-income settings has spanned training, barriers and attitudes, job aides, incentives, accountability, motivation, and management and supervision amongst others, but often as specific issues [4,42,43,54,57,58].”
The devil is in the details: The successes and limitations of bureaucratic reform in India
Dhaliwal, I., & Hanna, R. (2017) · Journal of Development Economics · doi:10.1016/j.jdeveco.2016.08.008 · Cited by 79 · see citing works
Digital technology for health sector governance in low and middle income countries: A scoping review
Holeman, I., Cookson, T. P., & Pagliari, C. (2016) · Journal of Global Health · doi:10.7189/jogh.06.020408 · Cited by 105 · see citing works
Left Behind? Citizen Responsiveness to Government Performance Information
Holbein, J. B. (2016) · American Political Science Review · doi:10.1017/s0003055416000071 · Cited by 95 · see citing works
The Effects of Chronic Disease Management in Primary Health Care: Evidence from Rural China
Ding, H., Chen, Y., Yu, M., Zhong, J., Hu, R., Chen, X., Wang, C., Xie, K., & Eggleston, K. N. (2021) · Journal of Health Economics · doi:10.1016/j.jhealeco.2021.102539 · Cited by 93 · see citing works
“Studies have explored the impact of financial incentives on healthcare workers’ performance ( Gertler and Vermeersch, 2012; Huillery and Seban, 2014; Miller and Babiarz, 2013 ) or other organizational and accountability mechanisms, including peer monitoring, unconditional non-monetary gifts, and community-based monito…”
Preventing rather than punishing: An early warning model of malfeasance in public procurement
Gallego, J., Rivero, G., & Martínez, J. D. (2020) · International Journal of Forecasting · doi:10.1016/j.ijforecast.2020.06.006 · Cited by 75 · see citing works
Ho, L., Labrecque, G., Batonon, I., Salsi, V., & Ratnayake, R. (2015) · Conflict and Health · doi:10.1186/s13031-015-0055-4 · Cited by 75 · see citing works
“problems that can be solved at the very local level, similar to findings from Bjorkman and Svensson in Uganda [17].”
How decentralisation influences the retention of primary health care workers in rural Nigeria
Abimbola, S., Olanipekun, T., Igbokwe, U., Negin, J., Jan, S., Martiniuk, A., Ihebuzor, N., & Aina, M. (2015) · Global Health Action · doi:10.3402/gha.v8.26616 · Cited by 75 · see citing works
- Authors
- Björkman, M., & Svensson, J.
- Affiliations
- Centre for Economic Policy Research (GB)
- Center for Economic and Policy Research (US)
- ORCID
- Svensson, Jakob
- Venue
- Quarterly Journal of Economics
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-05
- Volume
- 124
- Issue
- 2
- Pages
- 735-769
- ISSN
- 0033-5533 (ISSN-L)
- 1531-4650
- OpenAlex
- W3123010330
- Cited by
- 739
- References
- 48
- Citations by year
- 2026: 32 · 2025: 38 · 2024: 28 · 2023: 28 · 2022: 61 · 2021: 66 · 2020: 47 · 2019: 32 · 2018: 41 · 2017: 53 · 2016: 50 · 2015: 52 · 2014: 64 · 2013: 54 · 2012: 36
- FWCI
- 26.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Quarterly Journal of Economics (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Archivio istituzionale della Ricerca - Bocconi (submittedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Social Sciences › Safety Research › Poverty, Education, and Child Welfare
- Keywords
- community-based monitoring, primary care, community participation, village meetings, non-governmental organizations, health care utilization, child mortality, child weight
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