Doctoral Dissertation Research in Economics: Governance, Citizenship, and Accountability: Democracy and Health Care Provision

这项拟议的研究将使用实验方法来研究如何最好地改善政府问责，以此作为提高公共产品提供效率的一种方式。重点是卫生保健服务的提供，目的是查明拟议的研究方法是否有效。该项目将实施两个实验。第一个实验将包括一次季度会议，在会上，地方政治领导人将报告地方政府医疗机构向普通民众提供医疗服务的情况。这项实验旨在测试地方政客在卫生部门发挥监督作用的有效性。第二个实验涉及对地方政治领导人进行监督地方政府卫生中心的技能培训。这项研究的结果将有助于解决世界许多地区普遍存在的导致无法提供公共服务的管理问责问题。这一结果还有助于提高美国对低收入国家的外部援助计划的效率和效果。它还将提供各种途径，通过在世界许多地区持续的公民参与来改进公共产品的提供和民主治理。该项目是两项治理干预措施的可行性研究和试点随机对照试验，旨在解决卫生服务提供方面的限制。试点研究的目的是评估干预和数据收集活动的可行性。这项研究将围绕政客在提供医疗保健方面的表现所起的作用，实施两项干预措施：(A)通过与地方政客就医疗服务提供的质量举行季度报告会议，增加公民参与；(B)在监督地方政府医疗中心方面进行地方领导技能培训。数据收集将包括干预前和干预后的家庭调查和卫生设施审计，以及公民-政治家会议期间的观察性调查。尽管人们注意到治理在提供服务和发展方面的作用，但关于加强地方机构的干预措施的严格证据相对较少。与侧重于实验室干预的研究不同，这项研究将评估针对政治经济低效的治理干预。它还调查了医疗保健提供的供应方壁垒，这可能是许多国家医疗保健问题的另一个基本方面。总而言之，这项研究将揭示低资源卫生系统中的制度动态。这些干预措施本身可能会促进目标社区公共服务提供的显著改善。该项目还将促使公民持续参与治理，改变相关社区的政治参与性质。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

This proposed research will use experimental methods to study how best to improve government accountability as a way of improving the efficiency of providing public goods. The focus is on health care services provision and it is intended to find out whether the proposed approach to the research will work. The project will implement two experiments. The first experiment will involve a quarterly meeting in which local political leaders report on healthcare delivery at local government healthcare facilities to the general population. This experiment is designed as a test of how effectively local politicians are playing their supervisory roles in the health sector. The second experiment involves training of local political leaders on skills in monitoring local government health centers. The results of this research will help to address widespread management accountability failures that lead to inability to provide public services in many parts of the world. The results could also help improve the efficiency and effectiveness of US external assistance programs to low income countries. It will also provide ways of improving the delivery of public goods and democratic governance through sustained citizen engagement in many parts of the world. This project is a feasibility study and pilot randomized controlled trial of two governance interventions designed to address constraints on health service provision. The objective of the pilot study is to evaluate the feasibility of the intervention and data collection activities. Centering on the role of politicians' performance in delivering healthcare, the study will implement wo interventions: (a) increased citizen participation through quarterly reporting meetings with local politicians on the quality of health service delivery and (b) local leader skills training in monitoring local government health centers. Data collection will consist of pre- and post-intervention household surveys and health facility audits, along with observational surveys during the citizen-politician meetings. Despite the attention given to the role of governance in service delivery and development, relatively little rigorous evidence exists on interventions to strengthen local institutions. In contrast to studies that focus on interventions in laboratory settings, this study will evaluate a governance intervention targeting inefficiencies in the political economy. It also investigates supply-side barriers to healthcare delivery, which are likely another essential side of health care issues in many countries. Altogether, the study will shed light on institutional dynamics in low-resource health systems. The interventions themselves may spur significant improvements in public services delivery in the target communities. The project will also generate sustained citizen participation in governance, shifting the nature of political engagement in the involved communities.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.