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Excited to share our new, long in-the-works paper with @piaraffler and @DougParkerson investigating the impact of bottom-up accountability on healthcare outcomes in Uganda. Full paper [https://www.poverty-action.org/sites/default/files/publications/RPP_0.pdf …] Policy brief [https://www.poverty-action.org/study/community-based-monitoring-healthcare-providers-uganda …] 1/npic.twitter.com/00IBHwKEZs
Community monitoring -- providing citizens with information about service delivery shortfalls, and mobilizing them to apply bottom-up pressure in light of that information -- has been embraced as a promising approach to improving health outcomes in low-income countries. 2/
We tested a large randomized intervention w/14,000 people in 376 villages modeled on the landmark “Power to the People” study. We gave communities information about how their health centers performed & helped them mobilize to apply pressure to improve healthcare. 3/pic.twitter.com/MDB9USDRoW
But we were disappointed to find no impacts on the main healthcare outcomes: no changes in utilization rates, child mortality, or other health outcomes (although we did find modest positive impacts on the quality of care patients received & their satisfaction with that care). 4/pic.twitter.com/loCdfaITcC
Equally disappointing, the intervention did not lead citizens to apply pressure on underperforming health providers -- a disheartening result for those committed to effecting change by harnessing citizen engagement. Bottom-up pressure is extremely difficult to mobilize. 5/
One possible explanation for the difference: Uganda in 2014 was very different from 2004 when Bjorkman & Svensson collected their baseline data. In that time child mortality dropped from 128 to 64 per 1,000 births -- a 50% drop. 6/pic.twitter.com/mp4dNaNBDZ
Kudos to @poverty_action, @goal_global, @DFID_UK, @MinofHealthUG, and our other partners for their commitment to generating rigorous evidence and (re)testing tried solutions. We hope the paper contributes to a discussion on what kinds of interventions work in what contexts. 7/end
Dan, welcome to Twitter and thanks for this tweet-storm. What's the best way to ask you, Pia, and Doug questions about the paper? Can I fire away on Twitter? Best via email? Are you planning a webinar?
Hi David! GOAL Uganda, who participated and supported the study, would be very happy to share thoughts as well! We saw some positive changes following the RCT in key areas. Get in touch with our Dep Prog Director @VincentMujune if you'd like to know more!
Find it difficult to read a paper like this without Ugandan co-authors yet the study was done in the country and experts on the subject are in plenty. Writing a paper about Ugandan health system without a single Ugandan? Really?
If you read the paper you will find numerous people being acknowledged. One of them in Mbonye. Of course there are authorship guidelines which I suppose were followed.
I know that there are authorship guidelines and I am not in any way suggesting that people should be gifted authorship just because they are locals. But I think such a paper would be more meaningful and have more impact if we readers knew that Prof. Mbonye's ideas were included.
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