Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda

This paper presents a randomized …eld 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 sta¤ exert higher e¤ort 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. This project is a collaborative exercise involving many people. Foremost, we are deeply indebted to Frances Nsonzi and Ritva Reinikka for their contributions at all stages of the project. We would also like to acknowledge the important contributions of Gibwa Kajubi, Abel Ojoo, AnthonyWasswa, James Kanyesigye, Carolyn Winter, Ivo Njosa, Omiat Omongin, Mary Bitekerezo, and the …eld and data sta¤ with whom we have worked over the years. We thank the Uganda Ministry of Health, Planning Division, the World Bank’s Country O¢ ce in Uganda, and the Social Development Department, the World Bank, for their cooperation. We are grateful for comments and suggestions by Paul Gertler, Esther Du‡o, Abhijit Banerjee, and seminar and conference participants at LSE, Oxford, IGIER, MIT, World Bank, NTNU, Namur, CEPR/EUDN conference in Paris, and BREAD & CESifo conference in Venice. Finally, we wish to thank the Bank-Netherlands Partnership Program (BNPP), the World Bank Research Committee, the World Bank Africa Region division, and the Swedish International Development Agency, Department for Research Cooperation, for funding this research. Björkman also thanks Jan Wallander’s and Tom Hedelius’Research Foundation for funding. IGIER, University of Bocconi, and CEPR. Email: [email protected]. IIES, Stockholm University, NHH, and CEPR. Email: [email protected].