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

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ClinicalTrials.gov Identifier: NCT02879708
Recruitment Status : Active, not recruiting
First Posted : August 26, 2016
Last Update Posted : August 31, 2018
Sponsor:
Collaborators:
World Bank
University of North Carolina, Chapel Hill
Stanford University
Information provided by (Responsible Party):
Manoj, Duke University

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.


Condition or disease Intervention/treatment Phase
Health Behavior Other: Information Only Other: Information and Facilitation Not Applicable

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 300000 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Health Services Research
Official Title: Effect of Social Accountability on Improving Service Delivery and Outcomes in the Public Sector: a Cluster-Randomized Control Trial in Uttar Pradesh, India
Study Start Date : April 2015
Actual Primary Completion Date : July 2018
Estimated Study Completion Date : July 2019

Arm Intervention/treatment
No Intervention: Control
40 (of 120) randomly selected villages receive no intervention
Information Only
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
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 and Facilitation
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
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.




Primary Outcome Measures :
  1. Weight-for-height Z scores [ Time Frame: 12 months after intervention implementation ]

Secondary Outcome Measures :
  1. Satisfaction with providers - averaged from a rating index and/or constructed by a PCA on the rating index [ Time Frame: 12 months after intervention implementation ]
    Level of satisfaction with local healthcare providers, as estimated by (1) averaging rating scores across a satisfaction index (questions asking the respondent to rate aspects of their last experience with the provider on a scale of 1-5); and/or (2) running a principal components analysis on the same index and taking the first component.

  2. Participation - as measured from self-report [ Time Frame: 4 months, measured each month, and at 1 year during endline survey ]
    household participation in VHSNC meetings and attendance at VHNDs, measured by self-report

  3. U5 mortality rate [ Time Frame: 12 months after intervention implementation ]
    under 5 mortality rates

  4. incidence of diarrhea [ Time Frame: 12 months after intervention implementation ]
  5. duration of diarrhea illness [ Time Frame: 12 months after intervention implementation ]

Other Outcome Measures:
  1. Info spread [ Time Frame: 4 months, measured each month ]
    proportion of the village that received/retained information spread through the different info dissemination strategies



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • households residing in the villages selected for the evaluation

Exclusion Criteria:

  • none

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02879708


Locations
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India
Uttar Pradesh State Institute of Rural Development
Lucknow, Uttar Pradesh, India, 226202
Sponsors and Collaborators
Duke University
World Bank
University of North Carolina, Chapel Hill
Stanford University
Investigators
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Principal Investigator: Manoj Mohanan, PhD, MSPH Duke University

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

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Responsible Party: Manoj, Assistant Professor, Sanford School of Public Policy, Duke University
ClinicalTrials.gov Identifier: NCT02879708     History of Changes
Other Study ID Numbers: D0168
IE-P150365 ( Other Grant/Funding Number: World Bank Strategic Impact Evaluation Fund (SIEF) )
First Posted: August 26, 2016    Key Record Dates
Last Update Posted: August 31, 2018
Last Verified: August 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: The investigators plan to make the de-identified data set publicly available.
Keywords provided by Manoj, Duke University:
Social Accountability
Healthcare Quality
Health System Strengthening
Child Health
Childhood pneumonia
Childhood diarrhea