Effect of Social Accountability on Improving Service Delivery and Outcomes in the Public Sector in Uttar Pradesh, India

Summary

In several low and middle-income countries, Social Accountability (SA) interventions have been introduced as an innovative approach to governance, aiming to improve delivery of public services. These interventions typically include information provision to citizens regarding their rights/entitlements and local provider performance, and additionally, facilitation of community engagement with providers and officials.

The state government of Uttar Pradesh (UP) and the Uttar Pradesh Health Systems Strengthening Project (UPHSSP) have identified 12 districts where the social accountability initiative will be introduced on a priority basis. This study focuses on interventions in 2 of these districts (Sultanpur and Fatehpur), to study mechanisms through which information and collective action lead to improved accountability and outcomes. Within the 2 districts, the study is implemented as a cluster randomized evaluation with 120 villages randomized into 2 treatment arms and one control arm.

This study aims to: (a) measure the causal effect of SA interventions on key outcomes (health status, quality of service); (b) test the effectiveness of social networks based strategies to disseminate information for community engagement; and (c) study individuals' decisions to participate in collective action efforts in the context of social networks and information interventions. In addition to evaluating the impact of the SA interventions, the study aims to generate new knowledge on relative strengths of information seeding strategies, identifying those that maximize the spread of information through the village network, and subsequently estimate peer effects on participation decisions.

Conditions

• Health Behavior

Interventions

OTHER

Information Only

Households will receive information regarding their rights and entitlements pertaining to healthcare, certain health outcomes specific to their village, as well as health-related activities happening in their village (such as the VHSNC meetings and Village Health and Nutrition Days). Information will be disseminated through an initial visit to all households, and from then on either through (1) broadcast messages sent to households via mobile phone, (2) central individuals in the village social network who will be asked to spread that information, or (3) public officials charged with spreading the information throughout the village.

OTHER

Information and Facilitation

In addition to the information interventions described above, this intervention will provide trained facilitators to help community members engage in a participatory process with VHSNCs and identify key deficiencies for improvement in health services that most concern community members. The facilitators are trained to help organize meetings and are provided a detailed checklist of activities to be undertaken prior to the the meetings. The three key health workers at the village level (ASHA, ANM, and AWW) report to the local (village level) elected representatives and block level authorities, who receive feedback from the community in the accountability interventions.

Sponsors & Collaborators

• World Bank

  collaborator OTHER

• University of North Carolina, Chapel Hill

  collaborator OTHER

• Stanford University

  collaborator OTHER

• Duke University

  lead OTHER

Principal Investigators

• Manoj Mohanan, PhD, MSPH · Duke University

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2015-04-30

Primary Completion

2018-07-31

Completion

2021-02-28

Countries

• India

Study Locations