Doctoral Dissertation Research in Economics: Governance, Citizenship, and Accountability: Democracy and Health Care Provision

Regents Of The University Of Michigan - Ann Arbor, Ann Arbor MI

Investigators

Abstract

This proposed research will use experimental methods to study how best to improve government accountability as a way of improving the efficiency of providing public goods. The focus is on health care services provision and it is intended to find out whether the proposed approach to the research will work. The project will implement two experiments. The first experiment will involve a quarterly meeting in which local political leaders report on healthcare delivery at local government healthcare facilities to the general population. This experiment is designed as a test of how effectively local politicians are playing their supervisory roles in the health sector. The second experiment involves training of local political leaders on skills in monitoring local government health centers. The results of this research will help to address widespread management accountability failures that lead to inability to provide public services in many parts of the world. The results could also help improve the efficiency and effectiveness of US external assistance programs to low income countries. It will also provide ways of improving the delivery of public goods and democratic governance through sustained citizen engagement in many parts of the world. This project is a feasibility study and pilot randomized controlled trial of two governance interventions designed to address constraints on health service provision. The objective of the pilot study is to evaluate the feasibility of the intervention and data collection activities. Centering on the role of politicians' performance in delivering healthcare, the study will implement wo interventions: (a) increased citizen participation through quarterly reporting meetings with local politicians on the quality of health service delivery and (b) local leader skills training in monitoring local government health centers. Data collection will consist of pre- and post-intervention household surveys and health facility audits, along with observational surveys during the citizen-politician meetings. Despite the attention given to the role of governance in service delivery and development, relatively little rigorous evidence exists on interventions to strengthen local institutions. In contrast to studies that focus on interventions in laboratory settings, this study will evaluate a governance intervention targeting inefficiencies in the political economy. It also investigates supply-side barriers to healthcare delivery, which are likely another essential side of health care issues in many countries. Altogether, the study will shed light on institutional dynamics in low-resource health systems. The interventions themselves may spur significant improvements in public services delivery in the target communities. The project will also generate sustained citizen participation in governance, shifting the nature of political engagement in the involved communities. This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.