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

NCT02879708 | Completed DMC

• 2 other identifiers: 2017-0417IE-P150365
• Study Type: interventional
• Target: 105,000
• Locations: 1 country
• Sites: 1

Brief 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

Keywords

Social Accountability; Healthcare Quality; Health System Strengthening; Child Health; Childhood pneumonia; Childhood diarrhea

Outcome Measures

Primary Outcomes (1)

• Weight-for-height Z scores

  12 months after intervention implementation

Secondary Outcomes (5)

• Satisfaction with providers - averaged from a rating index and/or constructed by a PCA on the rating index

  12 months after intervention implementation

• Participation - as measured from self-report

  4 months, measured each month, and at 1 year during endline survey

• U5 mortality rate

  12 months after intervention implementation

• incidence of diarrhea

  12 months after intervention implementation

• duration of diarrhea illness

  12 months after intervention implementation

Other Outcomes (1)

• Info spread

  4 months, measured each month

Study Arms (3)

Control

NO INTERVENTION

40 (of 120) randomly selected villages receive no intervention

Information Only

OTHER

40 randomly selected villages are assigned to the "information only" arm where 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.

Other: Information Only

Information and Facilitation

OTHER

The remaining 40 villages will receive similar information as the villages in the Information Only Arm, but will also have facilitators present that ensure the existence of the VHSNC at the village level as well as the occurrence of VHSNC monthly meetings.

Other: Information and Facilitation

Interventions

Information Only OTHER

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.

Information Only

Information and Facilitation OTHER

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.

Information and Facilitation

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• households residing in the villages selected for the evaluation

You may not qualify if:

• none

Sponsors & Collaborators

• Duke University: lead
• World Bank: collaborator
• University of North Carolina, Chapel Hill: collaborator
• Stanford University: collaborator

Study Sites (1)

Uttar Pradesh State Institute of Rural Development

Lucknow, Uttar Pradesh, 226202, India

Location

Related Publications (1)

• Ringold, D., Holla, A., Koziol, M., & Srinivasan, S. (2012).

  BACKGROUND

MeSH Terms

Conditions

Health Behavior

Condition Hierarchy (Ancestors)

Behavior

Study Officials

• Manoj Mohanan, PhD, MSPH

  Duke University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Sanford School of Public Policy

Study Record Dates

• First Submitted: July 25, 2016
• First Posted: August 26, 2016
• Study Start: April 1, 2015
• Primary Completion: July 1, 2018
• Study Completion: February 1, 2021
• Last Updated: December 11, 2024

Record last verified: 2024-12

Data Sharing

• IPD Sharing: Will share

Locations

IN (1)