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Building Resilient Health Systems: Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak

Author

Listed:
  • Bilal Siddiqi

    (University of California, Los Angeles)

  • Darin Christensen

    (University of Chicago)

  • Oeindrila Dube

    (Princeton University, NBER, Busara Center for Behavioral Economics, and Max Planck Institute for Collective Goods)

  • Johannes Haushofer

    (University of California, Berkeley)

  • Maarten Voors

    (Wageningen University)

Abstract

Developing countries are characterized by high rates of mortality and morbidity. A potential contributing factor is the low utilization of health systems, stemming from the low perceived quality of care delivered by health personnel. This factor may be especially critical during crises, when individuals choose whether to cooperate with response efforts and frontline health personnel. We experimentally examine efforts aimed at improving health worker performance in the context of the 2014–15 West African Ebola crisis. Roughly two years before the outbreak in Sierra Leone, we randomly assigned two accountability interventions to government-run health clinics — one focused on community monitoring and the other gave status awards to clinic staff. We find that over the medium run, prior to the Ebola crisis, both interventions led to improvements in utilization of clinics and patient satisfaction with the health system. In addition, child health outcomes improved substantially in the catchment areas of community monitoring clinics. During the crisis, the interventions also led to higher reported Ebola cases, as well as lower mortality from Ebola—particularly in areas with community monitoring clinics. We explore three potential mechanisms: the interventions (1) increased the likelihood that patients reported Ebola symptoms and sought care; (2) unintentionally increased Ebola incidence; or (3) improved surveillance efforts. We find evidence consistent with the first: by building trust and confidence in health workers, and improving the perceived quality of care provided by clinics prior to the outbreak, the interventions encouraged patients to report and receive treatment. Our results suggest that accountability interventions not only have the power to improve health systems during normal times, but can additionally make health systems resilient to crises that may emerge over the longer run.

Suggested Citation

  • Bilal Siddiqi & Darin Christensen & Oeindrila Dube & Johannes Haushofer & Maarten Voors, 2020. "Building Resilient Health Systems: Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak," Empirical Studies of Conflict Project (ESOC) Working Papers 17, Empirical Studies of Conflict Project.
  • Handle: RePEc:pri:esocpu:17
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    File URL: https://esoc.princeton.edu/publications/esoc-working-paper-17-building-resilient-health-systems-experimental-evidence-sierra
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    References listed on IDEAS

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    Cited by:

    1. Bruno Carvalho & Susana Peralta & Joao Pereira dos Santos, 2020. "What and how did people buy during the Great Lockdown? Evidence from electronic payments," Working Papers ECARES 2020-20, ULB -- Universite Libre de Bruxelles.
    2. Mehdi Shadmehr & Ethan Bueno de Mesquita, 2020. "Coordination and Social Distancing: Inertia in the Aggregate Response to COVID-19," Working Papers 2020-53, Becker Friedman Institute for Research In Economics.

    More about this item

    Keywords

    Sierra Leone; Disease control & prevention; Ebola epidemic; Government accountability; Health systems; Monitoring; Non-monetary incentives; Public service delivery;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development

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