Information and Facilitation Interventions for Accountability in Health and Nutrition: Evidence from a Randomized Trial in India

58 Pages Posted: 28 Feb 2020 Last revised: 5 Mar 2020

See all articles by Manoj Mohanan

Manoj Mohanan

Duke University - Sanford School of Public Policy; Duke University - Department of Economics

Vikram S. Rajan

World Bank

Kendal Swanson

Duke University - Sanford School of Public Policy

Harsha Thirumurthy

University of Pennsylvania; Center for Health Incentives and Behavioral Economics, University of Pennsylvania; University of Pennsylvania - Population Studies Center

Date Written: February 1, 2020

Abstract

Community-based accountability interventions have shown potential to improve delivery of public services, but there is limited evidence on the effectiveness of such interventions when implemented at scale by developing country governments. We study the effectiveness of social accountability interventions implemented by the Indian state government of Uttar Pradesh aimed at improving delivery of primary health and nutrition services to children and pregnant women. Using a village level randomized trial design, we investigate two key mechanisms through which accountability interventions are hypothesized to improve healthcare delivery and health outcomes: information provision about health service entitlements and facilitation of collective action for community monitoring. We find large improvements in immunization rates, treatment of childhood diarrhea, and institutional delivery rates, modest improvements in child nutritional outcomes, and no effects on child mortality. Overall, the effects of information combined with facilitation are larger and statistically significant more often than that of providing information alone. We also find evidence of gender disparities with most of the average effects being driven by improvements among boys, with little to no effect of accountability interventions among girls.

Keywords: Accountability, Community, Information, Facilitation, Monitoring, Health

JEL Classification: C93, D7, H4, I12, I18

Suggested Citation

Mohanan, Manoj and Rajan, Vikram S. and Swanson, Kendal and Thirumurthy, Harsha, Information and Facilitation Interventions for Accountability in Health and Nutrition: Evidence from a Randomized Trial in India (February 1, 2020). Economic Research Initiatives at Duke (ERID) Working Paper No. 295, February 2020, Available at SSRN: https://ssrn.com/abstract=3544786 or http://dx.doi.org/10.2139/ssrn.3544786

Manoj Mohanan (Contact Author)

Duke University - Sanford School of Public Policy ( email )

201 Science Drive
Box 90312
Durham, NC 27708-0239
United States

Duke University - Department of Economics ( email )

213 Social Sciences Building
Box 90097
Durham, NC 27708-0204
United States

Vikram S. Rajan

World Bank

1818 H Street, NW
Washington, DC 20433
United States

Kendal Swanson

Duke University - Sanford School of Public Policy ( email )

201 Science Drive
Box 90312
Durham, NC 27708-0239
United States

Harsha Thirumurthy

University of Pennsylvania ( email )

423 Guardian Dr
Philadelphia, PA 19104
United States

Center for Health Incentives and Behavioral Economics, University of Pennsylvania ( email )

Philadelphia, PA 19104
United States

University of Pennsylvania - Population Studies Center ( email )

PA
United States

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