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1. Building Resilient Health Systems: Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak

Author:
Bilal Siddiqi, Maarten Voors, Johannes Haushofer, Oeindrila Dube, and Darin Christensen
Publication Date:
03-2020
Content Type:
Working Paper
Institution:
Empirical Studies of Conflict Project (ESOC)
Abstract:
Developing countries are characterized by high rates of mortality and morbidity. A potential contributing factor is the low utilization of health systems, stemming from the low perceived quality of care delivered by health personnel. This factor may be especially critical during crises, when individuals choose whether to cooperate with response efforts and frontline health personnel. We experimentally examine efforts aimed at improving health worker performance in the context of the 2014–15 West African Ebola crisis. Roughly two years before the outbreak in Sierra Leone, we randomly assigned two accountability interventions to government-run health clinics — one focused on community monitoring and the other gave status awards to clinic staff. We find that over the medium run, prior to the Ebola crisis, both interventions led to improvements in utilization of clinics and patient satisfaction with the health system. In addition, child health outcomes improved substantially in the catchment areas of community monitoring clinics. During the crisis, the interventions also led to higher reported Ebola cases, as well as lower mortality from Ebola—particularly in areas with community monitoring clinics. We explore three potential mechanisms: the interventions (1) increased the likelihood that patients reported Ebola symptoms and sought care; (2) unintentionally increased Ebola incidence; or (3) improved surveillance efforts. We find evidence consistent with the first: by building trust and confidence in health workers, and improving the perceived quality of care provided by clinics prior to the outbreak, the interventions encouraged patients to report and receive treatment. Our results suggest that accountability interventions not only have the power to improve health systems during normal times, but can additionally make health systems resilient to crises that may emerge over the longer run.
Topic:
Health, Infectious Diseases, Health Care Policy, Mortality, Public Health, and Pandemic
Political Geography:
West Africa and Sierra Leone

2. Explaining the Health Status of Children in Sierra Leone: Parental Socioeconomic Status and Demand for Health Inputs

Author:
Mohamed Jalloh and Santigie Mohamed Kargbo
Publication Date:
11-2012
Content Type:
Policy Brief
Institution:
African Economic Research Consortium (AERC)
Abstract:
In most developing countries, maternal and child health issues have received considerable attention in public health policies and pose formidable challenges. Several studies provide evidence of a strong relationship between socioeconomic factors such as economic growth, poverty, water and sanitation, education and gender and health outcomes. A good number of researchers have shown that a mother’s use of child health care is influenced by the risk of child mortality. It is thus been emphasized in the literature that the decision to obtain health inputs is confronted with the potential issue of self-selection and hence endogeneity.
Topic:
Economics, Health, Health Care Policy, Children, Child Poverty, Domestic Politics, and Mortality
Political Geography:
Africa and Sierra Leone