Suchergebnisse

The impact of armed conflict may persist long after the end of war, and may include a lasting institutional legacy. We use a novel dataset from rural Burundi to examine the impact of local exposure to conflict on institutional quality, and try to 'unbundle' institutions by distinguishing between three dimensions of the institutional framework: property rights security, local political institutions, and social capital. We find that conflict exposure affects institutional quality, and document that the impact of conflict on institutional quality may be positive or negative, depending on the institutional measure. Specifically, exposure to violence strengthens in-group social capital and promotes tenure security. However, the appreciation for state institutions is negatively affected by exposure to violence. We find no evidence consistent with design-based theories of institutional quality, or the idea that institutional quality is enhanced by interventions of (non)state external actors. Instead our findings provide some support for the theory of parochial altruism. Our results emphasize the importance for policymakers to consider autonomous responses to conflict when designing development programs. They further imply some caution for actors seeking to reform local institutions through top-down interventions.

This book argues that development strategies have thus far failed in Western Africa because the many challenges afflicting the area have yet to be explored and understood from the perspective of institutional resources. With a particular focus on three countries on the bend of the Upper West African coast - Guinea, Liberia and Sierra Leone - this book offers a theory to account for the nature of these institutional elements, to test deductions against evidence, and finally to propose a reset for rural development policy to make fuller use of local institutional resources. Based on quantitative analysis and eight years of multidisciplinary field research, this volume features several large-scale RCTs in the domain of rural development, local governance, and nature conservation. The authors address one of the biggest topics in agricultural and development economics today: the structural transformation of poor, agrarian economies, and they do so through the important and unique lens of institutions.--

Abstract
We evaluate the long-run effects of a decentralised approach to economic development called community-driven development—a prominent strategy for delivering foreign aid—by revisiting a randomised community-driven development program in Sierra Leone 11 years after launch. We estimate large persistent gains in local public goods and market activity, and modest positive effects on institutions. There is suggestive evidence that community-driven development may have slightly improved the communities' response to the 2014 Ebola epidemic. We compare estimates to the forecasts of experts from Sierra Leone and abroad, working in policy and academia, and find that local policymakers are overly optimistic about the effectiveness of community-driven development.

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.

Developing countries are characterized by high rates of mortality and morbidity. A potential contributing factor is the low utilization of health systems, stemming from the low perceived quality of care delivered by health personnel. This factor may be especially critical during crises, when individuals choose whether to cooperate with response efforts and frontline health personnel. We experimentally examine 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, we randomly assigned two accountability interventions to government-run health clinics — one focused on community monitoring and the other gave status awards to clinic staff. We find that over the medium run, prior to the Ebola crisis, both inter-ventions led to improvements in utilization of clinics and patient satisfaction with the health system. In addition, child health outcomes improved substantially in the catchment areas of community monitoring clinics. During the crisis, the interventions also led to higher reported Ebola cases, as well as lower mor-tality from Ebola — particularly in areas with community monitoring clinics. We explore three potential mechanisms: the interventions (1) increased the likelihood that patients reported Ebola symptoms and sought care; (2) unintentionally increased Ebola incidence; or (3) improved surveillance efforts. We find evidence consistent with the first: 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. Our results suggest that accountability interventions not only have the power to improve health systems during normal times, but can additionally make health systems resilient to crises that may emerge over the longer run.