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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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“With few exceptions, this literature studies the relationships of accountability of politicians to citizens and deal with one (periodic elections) mechanism through which citizens can make politicians and policymakers accountable (see for instance Strömberg, 2004; Besley and Burgess, 2002; Ferraz and Finan, 2005).”
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“An individual worker may still put in high e¤ort if shirking deviates from her ideal choice, given the behavior of other sta¤ and the situation (Akerlof and Kranton, 2005).”
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Missing in action: teacher and health worker absence in developing countries.
Chaudhury, N., Hammer, J., Kremer, M., Muralidharan, K., & Rogers, F. H. (2006) · Journal of Economic Perspectives · doi:10.1257/089533006776526058 · Cited by 1,379 · cited 3×
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InfluentialFerraz, C., & Finan, F. (2008) · Quarterly Journal of Economics · doi:10.1162/qjec.2008.123.2.703 · Cited by 1,319
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Self-citationHandcuffs for the Grabbing Hand? Media Capture and Government Accountability
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“See also Björkman and Svensson (2009) and Charness and Gneezy (2009), among others.”
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InfluentialNiyongabo, P., Douwes, R., Dieleman, M., Irambona, F., Mategeko, J., Nsengiyumva, G., & Buning, T. D. C. (2018) · BMC Health Services Research · doi:10.1186/s12913-017-2822-y · Cited by 8
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“Bjorkmann and Svenson used this effect in rural Uganda by employing community workers to improve local accountability of the public providers.(33) A reduction in the under-five mortality (33% improvement one year into the program) was seen in the experimental villages without effort in improving training or infrastruc…”
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Atela, M. (2013) · Apollo (University of Cambridge) · doi:10.17863/cam.16253 · Cited by 7
Bold, T., & Svensson, J. (2013) · doi:10.1093/jae/ejt012 · Cited by 7
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“It is mostly the lack of knowledge of the existing financial opportunities that discourages drillers from taking investment loans and less so the scarcity of credit from the banking system (Björkman and Svensson, 2007).”
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“[10] Björkman, Martina and Jakob Svensson (2009).”
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“Björkman and Svensson [8] also document that child mortality in Uganda is reduced when public primary healthcare providers are monitored by their communities.”
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Absence: Electoral Cycles and Teacher Absenteeism in India
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“11 Service recipients can put pressure on front-line functionaries through increased monitoring (Banerjee et al. 2010; Raffler, Posner and Parkerson 2018), better information (Björkman and Svensson 2009), and voicing disaffection to bureaucrats or politicians (Hirschman 1970).”
Gondwe, M., Mndala, L., Kondoni, C., Khumalo, A. K., Maseko, B., Munthali, L., Bamuya, C., Bilesi, R., Phiri, H., Kachale, F., et al. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12468-4 · Cited by 4
“Health facilities may also benefit communities’ health literacy over the longer term by sharing accurate data on maternal indicators to raise awareness and indicate local change and progress over time [55–57].”
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Unintended environmental consequences of anti-corruption strategies
Cisneros, E., & Kis‐Katos, K. (2021) · Journal of Environmental Economics and Management · doi:10.1016/j.jeem.2024.103073 · Cited by 14
Primeau, M., Jobin-Gélinas, M., Mayabanza, C. M., Mayaza, M., & Blouin, G. (2024) · International Journal of Health Planning and Management · doi:10.1002/hpm.3854 · Cited by 4
“6,35,36 Our study also questioned the ability of user committees to empower patient engagement in the individual care level in contexts where medical paternalism is prominent.”
Jiang, S.-G., Wei, Q., & Zhao, L. (2024) · China economic review · doi:10.1016/j.chieco.2024.102158 · Cited by 4
Does Democracy Matter for Lifespan Inequalities? Regime Type and Premature Mortality by Sex
Salazar, A. O., Rodríguez, J. M., Salayeva, R., & Rogers, M. Z. (2023) · Studies in Comparative International Development · doi:10.1007/s12116-023-09407-x · Cited by 4
“Latin America is also an important region to examine as variation in premature mortality has increased due to interpersonal violence, road injuries, and ischemic heart diseases as the leading causes (Wang et al. 2016).”
Pratolo, S., Mukti, A. H., & Sofyani, H. (2022) · Journal of Accounting and Investment · doi:10.18196/jai.v23i2.14324 · Cited by 4
“It is consistent with Bjorkman and Svensson (2009) and Lieberman et al. (2014), which uncovered that the quality of service would increase with good transparency practices.”
Kays, M., Woelk, G., Callahan, T., Katirayi, L., Montandon, M., Chauwa, F., Laterra, A., Sampathkumar, V., Kayira, D., Kalua, T., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255788 · Cited by 4
“One means of addressing persistent and modifiable barriers to quality care is using social accountability approaches to empower clients and communities [14,15].”
Mwale, P. M., Msiska, T., Wako, E., Chinkhota, K., Munthali, T., Rodriguez, M. A., Shato, T., Laterra, A., & Kuhlmann, A. S. S. (2021) · Frontiers in Reproductive Health · doi:10.3389/frph.2021.645280 · Cited by 4
“Young people highlighted three important aspects of the CSC process as helping facilitate sustainability: (1) providing a safe space for them to speak out and building agency that enables them to work with various offices and be heard as an important stakeholder group in the community and to identify problems without…”
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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