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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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“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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Monitoring Corruption: Evidence from a Field Experiment in Indonesia
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“Björkman and Svensson (2009) studied the impact of community-based monitoring on healthcare delivery in Uganda, by tracking the impact of ‘citizen report cards’ from 55,000 households on local health services.”
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“Uganda, India (Björkman and Svensson, 2009; Duflo et al., 2008)”
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“…2002; Mansuri and Rao, 2004; World Bank, 2004), the existing literature has found mixed evidence on its effectiveness (Olken, 2007; Banerjee and Duflo, 2006; Björkman and Svensson, 2009; Banerjee et al., 2010; Grossman et al., 2018; Buntaine et al., 2021ab; Garbiras-Días and Montenegro 2022).”
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“Similarly, Björkman and Svensson (2009) noted how a lack of information and a failure to agree on what is reasonable to expect or demand from service providers inhibited community members from effectively monitoring health facilities.”
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“Uganda, India (Björkman and Svensson 2009; Duflo et al. 2008)”
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“Other studies have shown the effectiveness of community monitoring in promoting the performance of professional health workers [34] and CHWs [35,36].”
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“randomized field experiment [21].”
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“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…”
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“It has also been shown to drive decisions about care seeking [63].”
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“…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).”
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“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.”
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Pieterse, P., & Lodge, T. (2015) · International Health · doi:10.1093/inthealth/ihv024 · Cited by 79
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“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…”
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“problems that can be solved at the very local level, similar to findings from Bjorkman and Svensson in Uganda [17].”
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Metadata
- 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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Social Sciences › Development › 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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