In Uganda, researchers conducted a large-scale randomized evaluation of a program called Accountability Can Transform (ACT) Health. The program provided community members and health care workers information about the quality of their local health services and brought them together to create action plans for how to improve local health service accountability, delivery, and quality. The study built on previous research of a similar program called Power to the People, which was found to greatly improve child health.
Twenty months after the program began:1
- The program marginally improved the quality of treatment patients received and increased patient satisfaction.
- However, the program did not affect how often people sought health care (utilization rates) or improve health outcomes; child mortality rates were unchanged.
- Results were similar one and two years into the program and were consistent across different groups; no health effects were found in any subgroup.
- Contrary to the theory of change motivating the intervention, there was no evidence that the program caused citizens to more closely monitor or apply pressure on service providers.
- Overall, the findings suggest a combination of information provision and increased oversight can marginally change the behavior of frontline service providers, but cast doubt on the power of information to foster community monitoring or to generate improvements in health outcomes, including child mortality, at least in the short term.
1 On average the time between the launch of the program and the final survey was 20 months.
Designers and funders of payments for ecosystem services (PES) programs have long worried that payments flow to landholders who would have conserved forests even without the program, undermining the environmental benefits (“additionality”) and cost-effectiveness of PES. If landholders self-select into PES programs based on how much conservation they were going to undertake anyway, then those who were planning to conserve should always enroll. This paper discusses the less-appreciated fact that enrollment is often based on other factors too. The hassle of signing up or financial costs of enrollment (e.g., purchasing seedlings) can affect who participates in a PES program. These enrollment costs reduce overall take-up, and, importantly, they can also influence the composition of landholders who select into the program—and thereby the program’s environmental benefits per enrollee. Enrollment costs can increase a program’s benefits per enrollee if they are systematically higher for (and thus deter enrollment by) landholders who would have conserved anyway. Alternatively, enrollment costs can dampen per-enrollee benefits if their correlation with status-quo conservation is in the opposite direction. We illustrate these points with evidence from two studies of randomized trials of PES programs aimed at increasing forest cover in Uganda and Malawi. We also discuss how in other sectors, such as social welfare, policy designers have purposefully adjusted the costs of program enrollment to influence the composition of participants and improve cost-effectiveness. We propose that these ideas for targeting could be incorporated into the design of PES programs.
In 2008, Uganda granted hundreds of small groups $400/person to help members start individual skilled trades. Four years on, an experimental evaluation found grants raised earnings by 38% (Blattman, Fiala, Martinez 2014). We return after 9 years to find these start-up grants acted more as a kick-start than a lift out of poverty. Grantees' investment leveled off; controls eventually increased their incomes through business and casual labor; and so both groups converged in employment, earnings, and consumption. Grants had lasting impacts on assets, skilled work, and possibly child health, but had little effect on mortality, fertility, health or education.
Do social networks matter for the adoption of new political communication technologies? We collect complete social network data for sixteen Ugandan villages where an innovative reporting mobile platform was recently introduced, and show robust evidence of peer effects on technology adoption. However, peer effects were not observed in all networks. We develop a formal model showing that while peer effects facilitate adoption of technologies with minimal externalities (like agricultural practices), it can be more difficult for innovations with significant positive externalities to spread through a network. Early adopters might exaggerate benefits, leading others to discount information about the technology’s value. Thus, peer effects are likely to emerge only where informal institutions support truthful communication. We show that the observable implications of our model are borne out in the data. These impediments to social diffusion might help explain the slow and varied uptake of new political communication technologies around the world.
Politicians shirk when their performance is obscure to constituents. We theorize that when politician performance information is disseminated early in the electoral term, politicians will subsequently improve their performance in anticipation of changes in citizens’ evaluative criteria and possible challenger entry in the next election. However, politicians may only respond in constituencies where opposition has previously mounted. We test these predictions in partnership with a Ugandan civil society organization in a multiyear field experiment conducted in 20 district governments between the 2011 and 2016 elections. While the organization published yearly job duty performance scorecards for all incumbents, it disseminated the scorecards to constituents for randomly selected politicians. These dissemination efforts induced politicians to improve performance across a range of measures, but only in competitive constituencies. Service delivery was unaffected. We conclude that, conditional on electoral pressure, transparency can improve politicians’ performance between elections but not outcomes outside of their control.