IDEAS home Printed from https://ideas.repec.org/p/cid/wpfacu/352.html
   My bibliography  Save this paper

Can Transparency and Accountability Programs Improve Health? Experimental Evidence from Indonesia and Tanzania

Author

Listed:
  • Dan Levy

    (Center for International Development at Harvard University)

Abstract

We assess the impact of a transparency and accountability program designed to improve maternal and newborn health (MNH) outcomes in Indonesia and Tanzania. Co-designed with local partner organizations to be community-led and non-prescriptive, the program sought to encourage community participation to address local barriers in access to high quality care for pregnant women and infants. We evaluate the impact of this program through randomized controlled trials (RCTs), involving 100 treatment and 100 control communities in each country. We find that on average, this program did not have a statistically significant impact on the use or content of maternal and newborn health services, nor the sense of civic efficacy or civic participation among recent mothers in the communities who were offered it. These findings hold in both countries and in a set of prespecified subgroups. To identify reasons for the lack of impacts, we use a mixed-method approach combining interviews, observations, surveys, focus groups, and ethnographic studies that together provide an in-depth assessment of the complex causal paths linking participation in the program to improvements in MNH outcomes. Although participation in program meetings was substantial and sustained in most communities, and most attempted at least some of what they had planned, only a minority achieved tangible improvements and fewer still saw more than one such success. Our assessment is that the main explanation for the lack of impact is that few communities were able to traverse the complex causal paths from planning actions to accomplishing tangible improvements in their access to quality health care.

Suggested Citation

  • Dan Levy, 2019. "Can Transparency and Accountability Programs Improve Health? Experimental Evidence from Indonesia and Tanzania," CID Working Papers 352, Center for International Development at Harvard University.
  • Handle: RePEc:cid:wpfacu:352
    as

    Download full text from publisher

    File URL: https://growthlab.cid.harvard.edu/files/growthlab/files/2019-05-cid-wp-352-improve-health.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Yoav Benjamini & Abba M. Krieger & Daniel Yekutieli, 2006. "Adaptive linear step-up procedures that control the false discovery rate," Biometrika, Biometrika Trust, vol. 93(3), pages 491-507, September.
    2. Katherine Casey & Rachel Glennerster & Edward Miguel, 2012. "Reshaping Institutions: Evidence on Aid Impacts Using a Preanalysis Plan," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(4), pages 1755-1812.
    3. Abhijit Banerjee & Rema Hanna & Jordan Kyle & Benjamin A. Olken & Sudarno Sumarto, 2018. "Tangible Information and Citizen Empowerment: Identification Cards and Food Subsidy Programs in Indonesia," Journal of Political Economy, University of Chicago Press, vol. 126(2), pages 451-491.
    4. Fiala,Nathan V. & Premand,Patrick, 2018. "Social accountability and service delivery : experimental evidence from Uganda," Policy Research Working Paper Series 8449, The World Bank.
    5. Martina Björkman & Jakob Svensson, 2009. "Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 735-769.
    6. Tahir Andrabi & Jishnu Das & Asim Ijaz Khwaja, 2017. "Report Cards: The Impact of Providing School and Child Test Scores on Educational Markets," American Economic Review, American Economic Association, vol. 107(6), pages 1535-1563, June.
    7. Deaton, Angus & Cartwright, Nancy, 2018. "Understanding and misunderstanding randomized controlled trials," Social Science & Medicine, Elsevier, vol. 210(C), pages 2-21.
    8. Anuradha Joshi & Peter P. Houtzager, 2012. "Widgets or Watchdogs?," Public Management Review, Taylor & Francis Journals, vol. 14(2), pages 145-162, February.
    9. Abhijit V. Banerjee & Rukmini Banerji & Esther Duflo & Rachel Glennerster & Stuti Khemani, 2010. "Pitfalls of Participatory Programs: Evidence from a Randomized Evaluation in Education in India," American Economic Journal: Economic Policy, American Economic Association, vol. 2(1), pages 1-30, February.
    10. Lant Pritchett & Salimah Samji & Jeffrey S. Hammer, 2012. "It's All about MeE: Using Structured Experiential Learning ('e') to Crawl the Design Space," WIDER Working Paper Series wp-2012-104, World Institute for Development Economic Research (UNU-WIDER).
    11. Angus Deaton & Nancy Cartwright, 2016. "Understanding and Misunderstanding Randomized Controlled Trials," Working Papers august_25.pdf, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
    12. Elisabeth King & Cyrus Samii & Birte Snilstveit, 2010. "Interventions to promote social cohesion in sub-Saharan Africa," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 2(3), pages 336-370.
    13. Ezequiel Molina & Laura Carella & Ana Pacheco & Guillermo Cruces & Leonardo Gasparini, 2017. "Community monitoring interventions to curb corruption and increase access and quality in service delivery: a systematic review," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 9(4), pages 462-499, October.
    14. Benjamin A. Olken, 2007. "Monitoring Corruption: Evidence from a Field Experiment in Indonesia," Journal of Political Economy, University of Chicago Press, vol. 115(2), pages 200-249.
    15. Lieberman, Evan S. & Posner, Daniel N. & Tsai, Lily L., 2014. "Does Information Lead to More Active Citizenship? Evidence from an Education Intervention in Rural Kenya," World Development, Elsevier, vol. 60(C), pages 69-83.
    16. Fox, Jonathan A., 2007. "Accountability Politics: Power and Voice in Rural Mexico," OUP Catalogue, Oxford University Press, number 9780199208852.
    17. Howard White, 2011. "Achieving high-quality impact evaluation design through mixed methods: the case of infrastructure," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 3(1), pages 131-144.
    18. Fox, Jonathan A., 2015. "Social Accountability: What Does the Evidence Really Say?," World Development, Elsevier, vol. 72(C), pages 346-361.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Kyando, Doreen Nico, 2022. "Social accountability initiatives in the delivery of public services in Sub-Saharan Africa: a systematic literature review," IOB Discussion Papers 2022.03, Universiteit Antwerpen, Institute of Development Policy (IOB).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Arkedis, Jean & Creighton, Jessica & Dixit, Akshay & Fung, Archon & Kosack, Stephen & Levy, Dan & Tolmie, Courtney, 2019. "Can Transparency and Accountability Programs Improve Health? Experimental Evidence from Indonesia and Tanzania," Working Paper Series rwp19-020, Harvard University, John F. Kennedy School of Government.
    2. Arkedis, Jean & Creighton, Jessica & Dixit, Akshay & Fung, Archon & Kosack, Stephen & Levy, Dan & Tolmie, Courtney, 2021. "Can transparency and accountability programs improve health? Experimental evidence from Indonesia and Tanzania," World Development, Elsevier, vol. 142(C).
    3. Fox, Jonathan A., 2015. "Social Accountability: What Does the Evidence Really Say?," World Development, Elsevier, vol. 72(C), pages 346-361.
    4. Kahsay, Goytom Abraha & Bulte, Erwin, 2021. "Internal versus top-down monitoring in community resource management: Experimental evidence from Ethiopia," Journal of Economic Behavior & Organization, Elsevier, vol. 189(C), pages 111-131.
    5. Afridi, Farzana & Dhillon, Amrita & Chaudhuri, Arka Roy & Kaur, Dashleen, 2020. "Efficacy of Top down audits and Community Monitoring," OSF Preprints akpdy, Center for Open Science.
    6. Darin Christensen & Oeindrila Dube & Johannes Haushofer & Bilal Siddiqi & Maarten Voors, 2021. "Building Resilient Health Systems: Experimental Evidence from Sierra Leone and The 2014 Ebola Outbreak," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(2), pages 1145-1198.
    7. Igor Francetic & Günther Fink & Fabrizio Tediosi, 2021. "Impact of social accountability monitoring on health facility performance: Evidence from Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 766-785, April.
    8. Allakulov, Umrbek & Cocciolo, Serena & Das, Binayak & Habib, Md. Ahasan & Rambjer, Lovisa & Tompsett, Anna, 2023. "Transparency, governance, and water and sanitation: Experimental evidence from schools in rural Bangladesh," Journal of Development Economics, Elsevier, vol. 163(C).
    9. Rao, Vijayendra & Ananthpur, Kripa & Malik, Kabir, 2017. "The Anatomy of Failure: An Ethnography of a Randomized Trial to Deepen Democracy in Rural India," World Development, Elsevier, vol. 99(C), pages 481-497.
    10. Afridi, Farzana & Basistha, Ahana & Dhillon, Amrita & Serra, Danila, 2023. "Activating Change: The Role of Information and Beliefs in Social Activism," IZA Discussion Papers 16358, Institute of Labor Economics (IZA).
    11. Kosec, Katrina & Wantchekon, Leonard, 2020. "Can information improve rural governance and service delivery?," World Development, Elsevier, vol. 125(C).
    12. Adnan M. S. Fakir & Tushar Bharati, 2022. "Healthy, nudged, and wise: Experimental evidence on the role of information salience in reducing tobacco intake," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1129-1166, June.
    13. Jiang, Shuguang & Wei, Qian & Zhao, Lei, 2024. "Synergizing anti-corruption strategies: Group monitoring and endogenous crackdown – An experimental investigation," China Economic Review, Elsevier, vol. 85(C).
    14. Jörg Peters & Jörg Langbein & Gareth Roberts, 2018. "Generalization in the Tropics – Development Policy, Randomized Controlled Trials, and External Validity," The World Bank Research Observer, World Bank, vol. 33(1), pages 34-64.
    15. Ardanaz, Martin & Otálvaro-Ramírez, Susana & Scartascini, Carlos, 2023. "Does information about citizen participation initiatives increase political trust?," World Development, Elsevier, vol. 162(C).
    16. World Bank Group, 2014. "Strategic Framework for Mainstreaming Citizen Engagement in World Bank Group Operations," World Bank Publications - Books, The World Bank Group, number 21113.
    17. Gaduh,Arya Budhiastra & Pradhan,Menno Prasad & Priebe,Jan & Susanti,Dewi, 2021. "Scores, Camera, Action : Social Accountability and Teacher Incentives in Remote Areas," Policy Research Working Paper Series 9748, The World Bank.
    18. Berry, James & Mehta, Saurabh & Mukherjee, Priya & Ruebeck, Hannah & Shastry, Gauri Kartini, 2021. "Crowd-out in school-based health interventions: Evidence from India’s midday meals program," Journal of Public Economics, Elsevier, vol. 204(C).
    19. Nyqvist, Martina Bjorkman & de Walque, Damien & Svensson, Jakob, 2014. "Information is power : experimental evidence on the long-run impact of community based monitoring," Policy Research Working Paper Series 7015, The World Bank.
    20. Vincenzo Di Maro & Stefan Leeffers & Danila Serra & Pedro C. Vicente, 2024. "Mobilizing Parents at Home and at School: An Experiment on Primary Education in Angola," Economic Development and Cultural Change, University of Chicago Press, vol. 72(3), pages 1069-1116.

    More about this item

    Keywords

    Health Outcomes;

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:cid:wpfacu:352. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Chuck McKenney (email available below). General contact details of provider: https://edirc.repec.org/data/ciharus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.