Governance, Citizenship, and Accountability: Community-Centered Development in the Ugandan Health Sector
The technologies needed to save millions of lives across the world each year have existed for decades. But how can governments resolve the many healthcare delivery failures that occur in the "last mile" of service provision—to ensure that these technologies reach those most in need?
Focusing on institutional and managerial quality, this project pilots two local governance programs aimed at making service delivery more accountable in the Ugandan health sector: (a) quarterly citizen reporting meetings with local leaders on health service delivery and (b) local leader skills training on monitoring government health centers.
Carried out as a four-arm randomized controlled trial, the project involves multiple forms of primary data collection, including a household survey, local leader survey, and health facility quality assessment. Through the activities, our team has pioneered the development of a body of high-quality implementation protocols for grassroots governance interventions. In contrast to many approaches, these programs aim to use existing resources more efficiently, offering an especially promising strategy for sustained development.
Omukazi Namagara Program: A Maternal and Neonatal Health Initiative
Launched in 2012 by Progressive Health Partnership, the Omukazi Namagara Program continues to bolster maternal and neonatal health services in the Ankole Region of Uganda. Taking a system-wide approach, the program builds on the Ugandan Ministry of Health’s national goals and strategies. The program includes interventions at both the facility level and village level that address barriers to care on both the supply-side and demand-side of health services.
The core components of the program consist of service provision strengthening at local health facilities and educational activities and home visits conducted by community health workers. Alongside the program, our team has carried out a rigorous academic evaluation, generating important, policy-relevant evidence on maternal and neonatal health. The results have been published in the Journal of Development Studies (manuscript version available here).
The Schooling Decision in the Presence of Incarceration Risk: A Life-Table Approach
Recent data from the U.S. indicate that black men obtain 12.8 years of education on average, while white men invest an average of 13.7 years in school. In collaboration with Hoyt Bleakley, this project examines the impact of incarceration and mortality disparities on this educational achievement gap. Specifically, we ask the following hypothetical question: if white men experienced the same mortality and incarceration rates as black men, how would they alter their choice of schooling years?
We find that incarceration disparities explain the majority of the gap in education between white and black men. This pathway running from incarceration risk to educational choice is grounded in basic economic intuition: an individual who expects to be incarcerated—and thus removed from the labor market in prime-earning years—has diminished incentives to go to school.
In contrast to many scholars and practitioners who stress the importance of education in reducing incarceration, our research elucidates the key role of underlying social inequalities in shaping the life and educational choices of black men.
Rainwater Harvesting: Promoting Safe Water, Sanitation, and Hygiene
Conceptualized in partnership with local community members in response to findings that access to safe drinking water was one of the most pressing needs in rural southwestern Uganda, this project has helped bring clean water to vulnerable communities on a large scale. The project has consisted of (a) the construction of rainwater harvesting tanks and (b) a water, sanitation, and hygiene education campaign.
Through the program, our team has constructed seventy-six 20,000-liter ferrocement rainwater harvesting tanks at public buildings throughout our partner communities, ensuring clean water, for the first time, at locations such as health facilities. In addition, our team has designed water, sanitation, and hygiene education activities carried out by community health workers. Finally, we have carried out the project in conjunction with field-based data collection to measure water quality and other related outcomes.