Information is Power: Experimental Evidence of the Long Run Impact of Community Based Monitoring

Poor quality plagues public service provision in many developing countries. In response, poli-cies to enhance beneficiary involvement as way to strengthen demand-responsiveness and local accountability are becoming increasingly popular. Despite the enthusiasm for this approach, however, the evidence provides mixed results about its short-run effectiveness. Whether it can lead to sustained improvements in service provision is largely unknown. This paper presents the results of two field experiments on local accountability in primary health care in Uganda. Efforts to stimulate beneficiary control, coupled with the provision of information on the staff’s performance, resulted in significant improvements in health care delivery and health outcomes in both the short and longer run. Efforts to stimulate beneficiary control without addressing users ’ lack of robust information on the clinic’s performance, on the contrary, had no mea-surable impact on the quality of care. We investigate the role of information and provide suggestive evidence showing that informed users are better able to distinguish between health workers ’ actions and factors outside the workers ’ control, and thereby in a better position to identify and challenge (mis)behavior by the provider. We are deeply indebted to Frances Nsonzi for her contributions at all stages of the project and acknowledge th