Management, Supervision, and Health Care: A Field Experiment

67 Pages Posted: 31 Aug 2017

See all articles by Felipe Dunsch

Felipe Dunsch

World Bank

David Evans

World Bank

Ezinne Eze-Ajoku

Johns Hopkins University

Mario Macis

Johns Hopkins University - Carey Business School; IZA Institute of Labor Economics; National Bureau of Economic Research (NBER)

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Abstract

If health service delivery is poorly managed, then increases in inputs or ability may not translate into gains in quality. However, little is known about how to increase managerial capital to generate persistent improvements in quality. We present results from a randomized field experiment in 80 primary health care centers (PHCs) in Nigeria to evaluate the effects of a health care management consulting intervention. One set of PHCs received a detailed improvement plan and nine months of implementation support (full intervention), another set received only a general training session, an overall assessment and a report with improvement advice (light intervention), and a third set of facilities served as a control group. In the short term, the full intervention had large and significant effects on the adoption of several practices under the direct control of the PHC staff, as well as some intermediate outcomes. Virtually no effects remained one year after the intervention concluded. The light intervention showed no consistent effects at either point. We conclude that sustained supervision is crucial for achieving persistent improvements in contexts where the lack of external competition fails to create incentives for the adoption of effective managerial practices.

Keywords: management, health care, supervision, economic development

JEL Classification: I15, M10, O15

Suggested Citation

Dunsch, Felipe and Evans, David and Eze-Ajoku, Ezinne and Macis, Mario, Management, Supervision, and Health Care: A Field Experiment. IZA Discussion Paper No. 10967, Available at SSRN: https://ssrn.com/abstract=3029838 or http://dx.doi.org/10.2139/ssrn.3029838

Felipe Dunsch (Contact Author)

World Bank ( email )

1818 H Street, NW
Washington, DC 20433
United States

David Evans

World Bank ( email )

1818 H Street, NW
Washington, DC 20433
United States

Ezinne Eze-Ajoku

Johns Hopkins University ( email )

Baltimore, MD 20036-1984
United States

Mario Macis

Johns Hopkins University - Carey Business School ( email )

100 International Drive
Baltimore, MD 21202
United States

IZA Institute of Labor Economics ( email )

P.O. Box 7240
Bonn, D-53072
Germany

National Bureau of Economic Research (NBER) ( email )

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Cambridge, MA 02138
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