Reducing Child Mortality in the Last Mile: A Randomized Social Entrepreneurship Intervention in Uganda

Out­line

In many de­vel­op­ing coun­tries, the pri­ma­ry strat­e­gy for ex­tend­ing pri­ma­ry health care from fa­cil­i­ties to un­der­served rur­al com­mu­ni­ties is com­mu­ni­ty health work­ers. Sys­tem­at­ic re­views of ex­ist­ing stud­ies show that com­mu­ni­ty health work­ers can be im­pact­ful in pro­mot­ing pos­i­tive health be­hav­ior and in pro­vid­ing ba­sic cu­ra­tive and health ser­vices. The find­ings from re­views of ran­dom­ized con­trolled tri­als of com­mu­ni­ty health work­er pro­grams and in­ter­ven­tions led by them, how­ev­er, are mixed. A lack of in­cen­tives for com­mu­ni­ty health work­ers to de­liv­er time­ly and ap­pro­pri­ate ser­vices has been high­light­ed as a key chal­lenge in tra­di­tion­al pro­grams. Specif­i­cal­ly, com­mu­ni­ty health work is of­ten vol­un­tary, but work­ers face com­pet­ing op­por­tu­ni­ties such as paid-work or home pro­duc­tion, that may lead them to de­vote less time to care­giv­ing. This might help ex­plain why strong im­pacts of com­mu­ni­ty health work­er pro­grams come from stud­ies in set­tings with high qual­i­ty of su­per­vi­sion and sup­port. Such a mon­i­tor­ing sys­tem may not be achiev­able in rou­tine field sit­u­a­tions. How to in­cor­po­rate in­cen­tives to mo­ti­vate com­mu­ni­ty health work­ers in large-scale pro­grams, and the im­pact that will have, are open ques­tions.

In­no­v­a­tive ap­proach to mo­ti­vate com­mu­ni­ty health work­ers

We as­sess a com­mu­ni­ty health work­er pro­gram in Ugan­da – the com­mu­ni­ty health pro­mot­er pro­gram – where com­mu­ni­ty health pro­mot­ers op­er­ate as mi­cro en­tre­pre­neurs earn­ing an in­come on the sale of pre­ven­tive and cu­ra­tive prod­ucts to keep them mo­ti­vat­ed and ac­tive in the com­mu­ni­ty. The un­der­ly­ing hy­poth­e­sis is that these in­cen­tives – cou­pled with small fi­nan­cial in­cen­tives to en­cour­age agents to reg­is­ter preg­nant women and vis­it new­borns with­in the first 48 hours of life – would mo­ti­vate agents to ac­tive­ly pro­vide In­te­grat­ed Com­mu­ni­ty Case Man­age­ment and Ma­ter­nal, New­born and Child Health ser­vices. We be­lieve the re­sults are like­ly to ad­vance a glob­al con­ver­sa­tion about how to best mo­ti­vate com­mu­ni­ty health work­ers to de­liv­er time­ly and ap­pro­pri­ate ser­vices.

Re­search Team

Author

David Yanagizawa-Drott

Professor of Development and Emerging Markets

Zurich ZCED

Mar­ti­na Bjo­erk­man-Nyqvist

Stock­holm Uni­ver­si­ty

An­drea Guar­iso

Trin­i­ty Col­lege Dublin

Jakob Svens­son

IIES, Stock­holm Uni­ver­si­ty