Publication: Working for God? Evidence from a Change in Financing of Nonprofit Health Care Providers in Uganda
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Date
2010
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15424766
Published
2010
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What motivates religious nonprofit health care providers? This paper uses a change in financing of nonprofit health care providers in Uganda to test two theories of organizational behavior. We show that financial aid leads to more laboratory testing, lower user charges, and increased utilization. These findings are consistent with the view that religious nonprofit providers are intrinsically motivated to serve (poor) people and that these preferences matter quantitatively.
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Publication Working for God? Evaluating Service Delivery of Religious Not-for-Profit Health Care Providers in Uganda(World Bank, Washington, DC, 2003-05)Reinikka and Svensson exploit a unique micro-level data set on primary health care facilities in Uganda to address the question: What motivates religious not-for-profit (RNP) health care providers? The authors use two approaches to identify whether an altruistic (religious) effect exists in the data. First, examining cross-section variation, they show that RNP facilities hire qualified medical staff below the market wage, are more likely to provide propoor services and services with a public good element, and charge lower prices for services than for-profit facilities, although they provide a similar (observable) quality of care. RNP and for-profit facilities both provide better quality care than their government counterparts, although government facilities have better equipment. These findings are consistent with the view that RNP facilities are driven in part by altruistic concerns and that these preferences matter quantitatively. Second, the authors exploit a near natural experiment in which the government initiated a program of financial aid for the RNP sector. They show that financial aid leads to more laboratory testing of suspected malaria and intestinal worm cases, and hence higher quality of service and lower prices, but only in RNP facilities. The findings suggest that working for God matters.Publication The Power of Information in Public Services: Evidence from Education in Uganda(2011)In this paper we argue that innovations in governance of social services are an effective way to improve outcomes such as attainment of universal primary education. To test this hypothesis we exploit an unusual policy experiment: a newspaper campaign in Uganda aimed at reducing the capture of public funds by providing schools (parents) with systematic information to monitor local officials' handling of a large education grant program. Combining survey and administrative data, we show that public access to information can be a powerful deterrent to the capture of funds at the local level and that the reduction in the capture of funds that resulted had a positive effect on school enrollment and learning outcomes.Publication Survey Techniques to Measure and Explain Corruption(World Bank, Washington, DC, 2003-06)Reinikka and Svensson demonstrate that, with appropriate survey methods and interview techniques, it is possible to collect quantitative micro-level data on corruption. Public expenditure tracking surveys, service provider surveys, and enterprise surveys are highlighted with several applications. While often broader in scope, these surveys permit measurement of corruption at the level of individual agents, such as schools, health clinics, or firms. They also permit the study of mechanisms responsible for corruption, including leakage of funds and bribery, as data on corruption can be combined with other data collected in these surveys.Publication The Power of Information: Evidence from a Newspaper Campaign to Reduce Capture(World Bank, Washington, D.C., 2003-12)The authors exploit an unusual policy experiment to evaluate the effects of increased public access to information as a tool to reduce capture and corruption of public funds. In the late 1990s, the Ugandan government initiated a newspaper campaign to boost schools' and parents' ability to monitor local officials' handling of a large school-grant program. The results were striking: capture was reduced from 80 percent in 1995 to less than 20 percent in 2001. The authors use distance to the nearest newspaper outlet as an instrument for exposure to the campaign. Proximity to a newspaper outlet is positively correlated with the head teachers' knowledge about rules governing the grant program and the timing of releases of funds from the center, but uncorrelated with test scores of general ability. A strong (reduced-form) relationship exists between proximity to a newspaper outlet and reduction in capture of school funds since the newspaper campaign started. This pattern contrasts sharply with the outcomes in the five-year period prior to the campaign. Instrumenting for head teachers' knowledge about the grant program, the authors find that public access to information is a powerful deterrent to capture at the local level.Publication Lessons from Uganda on Strategies to Fight Poverty(World Bank, Washington, DC, 2000-09)Countries receiving debt relief under the Heavily Indebted Poor Countries initiative will be among the first to benefit from the new World Bank -- International Monetary Fund approach to strengthening the impact on poverty of concessional assistance in low-income countries. The new approach features a more inclusive and participatory process for helping recipient countries develop poverty reduction strategies. From these strategies, joint Poverty Reduction Strategy Papers (PRSPs) will bring together the country's own priorities and Bank-Fund assistance to the country. In Uganda, such a strategy has existed for several years. Uganda was one of the first low-income countries to prepare a comprehensive national strategy for poverty reduction using a participatory approach. Indeed, its experience contributed substantially to the design of the PRSPs. Uganda's top leadership is heavily committed to poverty reduction. Formulation of Uganda's Poverty Eradication Action Plan (PEAP) in 1996-97 was the executive branch's effort to make that commitment and vision operational. The authors draw lessons from the drafting of Uganda's PEAP. First, the plan made extensive use of existing data and research about Uganda to refocus a range of public policies and interventions relevant to poverty reduction. Second, the government's approach was highly participatory, with central and local governments, the donor community, nongovernmental organizations and civil society, and academics invited to contribute. Third, the government was quick to translate the plan into its budget and medium-term spending framework. Public expenditures on basic services were significantly increased after adoption of the PEAP in 1997. The authors discuss the general characteristics of a poverty reduction action plan, drawing on Uganda's experience; discuss what is known about poverty in Uganda and identify shortcomings in the data; examine the macroeconomic and fiscal policies that were considered most important to poverty reduction during the participatory process; discuss the delivery of public services, especially those that directly affect the poor; and highlight problems associated with land issues, including problems with access to credit and financial services and with the security of productive assets.
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