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The paper chosen for the sake of this analysis is “Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda” by Björkman and Svensson published in The Quarterly Journal of Economic Journal. The authors of the paper intend to reduce the child mortality rate in the region of Sub-Sahara by using Uganda for the field experiment. The paper uses the method of randomization to test one intervention against the other. The results from the field experiment by the authors have been clearly stated in the paper. The success criteria and the rate of success have also been highlighted.
Primary Research Question
The key question that the paper addresses is whether the accountability and strong monitoring system by the citizens improve the health sector’s ability to deliver its services. The major focus of the paper is the accountability relationships in the context of citizen clients’ ability to pass responsibility to service providers, by using basic health care delivery in rural areas of Uganda as the testing ground (Björkman and Svensson 736).
The authors have undertaken this study to improve the delivery of health services in Uganda because the statistical study reveals that 11 million children under the age of five die in Sub-Saharan Africa because of diseases like malaria and measles (Björkman and Svensson 756). The study aims to check whether community-based monitoring helps improve this situation for the children.
The key-terms defined in the context of this study are accountability and community. As per the author’s accountability here is held synonymous with the involvement of the public in the health affairs of the region. Moreover, the community is an area that has a radius of five kilometers around any facility. In the context of this study, the authors have taken community as a body with 2500 homes and within a 5-km radius from the clinic.
A community-based randomized controlled field design has been used to conduct this study. The experiment involves a total of fifty public dispensaries, as well as the health-care users from the nine districts of Uganda; the studied project facilities are all located in the rural areas (Björkman and Svensson 740). For the experimental design of this study, the facilities are initially divided into groups by location and further on by the size of the population (Björkman and Svensson 740). Out of the fifty dispensaries, 25 units are randomly assigned as the treatment group and the rest is taken as the control group (Björkman and Svensson 740).
The research is divided into two parts: the pre-intervention and the post-intervention. The pre-intervention part of the study includes surveys to collect data on the quality of services and the type of health facilities available in Uganda. For the post-intervention phase, the chosen treatments are the report cards to pass on information about existing healthcare facilities and a series of meetings to the local population. The meetings are intended to encourage participation from the locals.
The empirical findings of the study indicate that following the pre-intervention survey the data disseminated to the local community created an impact of transparency. Following the meeting session after these surveys, the locals voiced their concerns openly which were communicated to the local council. The comparison of the control and the treatment group indicates that the communities in the treatment groups became more involved in the monitoring of the health service providers.
The intervention also enhanced the performance and behavior of health workers. Their behavior was measured by using the variables of “equipment used, waiting time, rate of absence, clinic management and health information management and dissemination” (Björkman and Svensson 758). The behavior of workers is reported to improve 20% more from the controlled baseline. The paper indicates an overall 7% reduction in the risk of mortality and it has been regarded as a huge impact by the authors and the communities involved. The other key-results from the experiment indicate that the dissemination of correct information to the local population plays a great role in holding the health-workers and concerned authorities accountable.
The research question for the research paper was laid-down and explained well by the authors in the context of Uganda. The study design using a specified case-study of Uganda and using pre-intervention and post-intervention approaches clearly showed the impact of treatment on the community. The treatment variables have been clearly defined and sufficiently executed by the authors. The comparisons drawn with the control group are fair and show the clarity of thought of the authors.
Björkman, Martina, and Jakob Svensson. “Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda”. The Quarterly Journal of Economics, vol. 124, no. 2, 2012, pp.735-769.