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

This paper experimentally examines 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, the study randomly assigned two accountability i...

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Main Authors:	Christensen, Darin, Dube, Oeindrila, Haushofer, Johannes, Siddiqi, Bilal, Voors, Maarten
Format:	Working Paper
Language:	English
Published:	World Bank, Washington, DC 2020
Subjects:	HEALTH SYSTEM EBOLA OUTBREAK HEALTH WORKERS CLINIC UTILIZATION PATIENT SATISFACTION CHILD HEALTH COMMUNITY MONITORING STAFF STATUS AWARD ACCOUNTABILITY
Online Access:	http://documents.worldbank.org/curated/en/612001588099765360/Building-Resilient-Health-Systems-Experimental-Evidence-from-Sierra-Leone-and-the-2014-Ebola-Outbreak http://hdl.handle.net/10986/33667

id	okr-10986-33667
recordtype	oai_dc
spelling	okr-10986-336672022-09-20T00:12:54Z Building Resilient Health Systems : Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak Christensen, Darin Dube, Oeindrila Haushofer, Johannes Siddiqi, Bilal Voors, Maarten HEALTH SYSTEM EBOLA OUTBREAK HEALTH WORKERS CLINIC UTILIZATION PATIENT SATISFACTION CHILD HEALTH COMMUNITY MONITORING STAFF STATUS AWARD ACCOUNTABILITY This paper experimentally examines 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, the study randomly assigned two accountability interventions to government-run health clinics—one focused on community monitoring and the other gave status awards to clinic staff. The findings show that, prior to the Ebola crisis, both interventions led to improvements in utilization of clinics, patient satisfaction with the health system, and child health outcomes. During the crisis, the interventions led to higher reported Ebola cases, as well as lower mortality from Ebola, particularly in areas with community monitoring clinics. The paper explores the potential mechanisms, and the findings provide evidence consistent with the following mechanism: 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. The results suggest that accountability interventions not only have the power to improve health systems during normal times, but also can make health systems resilient to crises that may emerge over the longer run. 2020-04-30T16:03:22Z 2020-04-30T16:03:22Z 2020-04 Working Paper http://documents.worldbank.org/curated/en/612001588099765360/Building-Resilient-Health-Systems-Experimental-Evidence-from-Sierra-Leone-and-the-2014-Ebola-Outbreak http://hdl.handle.net/10986/33667 English Policy Research Working Paper;No. 9223 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo World Bank World Bank, Washington, DC Publications & Research Publications & Research :: Policy Research Working Paper Africa Sierra Leone
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English
topic	HEALTH SYSTEM EBOLA OUTBREAK HEALTH WORKERS CLINIC UTILIZATION PATIENT SATISFACTION CHILD HEALTH COMMUNITY MONITORING STAFF STATUS AWARD ACCOUNTABILITY
spellingShingle	HEALTH SYSTEM EBOLA OUTBREAK HEALTH WORKERS CLINIC UTILIZATION PATIENT SATISFACTION CHILD HEALTH COMMUNITY MONITORING STAFF STATUS AWARD ACCOUNTABILITY Christensen, Darin Dube, Oeindrila Haushofer, Johannes Siddiqi, Bilal Voors, Maarten Building Resilient Health Systems : Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak
geographic_facet	Africa Sierra Leone
relation	Policy Research Working Paper;No. 9223
description	This paper experimentally examines 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, the study randomly assigned two accountability interventions to government-run health clinics—one focused on community monitoring and the other gave status awards to clinic staff. The findings show that, prior to the Ebola crisis, both interventions led to improvements in utilization of clinics, patient satisfaction with the health system, and child health outcomes. During the crisis, the interventions led to higher reported Ebola cases, as well as lower mortality from Ebola, particularly in areas with community monitoring clinics. The paper explores the potential mechanisms, and the findings provide evidence consistent with the following mechanism: 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. The results suggest that accountability interventions not only have the power to improve health systems during normal times, but also can make health systems resilient to crises that may emerge over the longer run.
format	Working Paper
author	Christensen, Darin Dube, Oeindrila Haushofer, Johannes Siddiqi, Bilal Voors, Maarten
author_facet	Christensen, Darin Dube, Oeindrila Haushofer, Johannes Siddiqi, Bilal Voors, Maarten
author_sort	Christensen, Darin
title	Building Resilient Health Systems : Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak
title_short	Building Resilient Health Systems : Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak
title_full	Building Resilient Health Systems : Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak
title_fullStr	Building Resilient Health Systems : Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak
title_full_unstemmed	Building Resilient Health Systems : Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak
title_sort	building resilient health systems : experimental evidence from sierra leone and the 2014 ebola outbreak
publisher	World Bank, Washington, DC
publishDate	2020
url	http://documents.worldbank.org/curated/en/612001588099765360/Building-Resilient-Health-Systems-Experimental-Evidence-from-Sierra-Leone-and-the-2014-Ebola-Outbreak http://hdl.handle.net/10986/33667
_version_	1764479276223037440

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

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