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

48 Pages Posted: 6 Jun 2019

See all articles by Jean Arkedis

Jean Arkedis

Harvard Kennedy School of Government

Jessica Creighton

Harvard University - Harvard Kennedy School (HKS)

Akshay Dixit

Harvard University - Harvard Kennedy School (HKS)

Archon Fung

Harvard University - Harvard Kennedy School (HKS)

Stephen Kosack

Harvard Kennedy School of Government; University of Washington

Dan Levy

Harvard University - Harvard Kennedy School (HKS)

Date Written: May 2019

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

Arkedis, Jean and Creighton, Jessica and Dixit, Akshay and Fung, Archon and Kosack, Stephen and Levy, Dan, Can Transparency and Accountability Programs Improve Health? Experimental Evidence from Indonesia and Tanzania (May 2019). HKS Working Paper No. RWP19-020. Available at SSRN: https://ssrn.com/abstract=3399124 or http://dx.doi.org/10.2139/ssrn.3399124

Jean Arkedis

Harvard Kennedy School of Government ( email )

111 Western Avenue 10 soldiers Field park apartmen
Boston, MA 02163
United States

Jessica Creighton

Harvard University - Harvard Kennedy School (HKS) ( email )

79 John F. Kennedy Street
Cambridge, MA 02138
United States

Akshay Dixit

Harvard University - Harvard Kennedy School (HKS) ( email )

79 John F. Kennedy Street
Cambridge, MA 02138
United States

Archon Fung

Harvard University - Harvard Kennedy School (HKS) ( email )

79 John F. Kennedy Street
Cambridge, MA 02138
United States
617-495-9846 (Phone)
617-496-1722 (Fax)

Stephen Kosack

Harvard Kennedy School of Government ( email )

111 Western Avenue 10 soldiers Field park apartmen
Boston, MA 02163
United States

University of Washington ( email )

Seattle, WA 98195
United States

Dan Levy (Contact Author)

Harvard University - Harvard Kennedy School (HKS) ( email )

79 John F. Kennedy Street
Cambridge, MA 02138
United States

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