Rachel Glennerster IGC Lead Academic for Sierra Leone and JPAL Health delivery challenge in Africa Simple highly costeffective prevention with low takeup Poor will spend on acute care not prevention ID: 402980
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Slide1
Learning from research to improve health delivery: case of Sierra Leone
Rachel Glennerster (IGC Lead Academic for Sierra Leone and JPAL)Slide2
Health delivery challenge in Africa
Simple highly cost-effective prevention with low
takeup
Poor will spend on acute care, not prevention
Underinvestment in health world wide phenomena
Research suggests often procrastination not hostility
Making prevention cheap (free) and convenient, substantially increases take up and is cost-effective
Kremer and
Glennerster
(2011)
But, with highly disbursed populations how do you provide convenient quality health care?
How do you monitor disbursed staff?Slide3
Access to clinics over
time, Sierra Leone
Source:
National Public Services Survey 2011,
DecSec
Slide4
Lessons from post war recoverySlide5
Lessons from research suggest way forward
Its cheaper to incentivize patients to come to clinics than to build more clinics or send health staff hamlet to hamlet
(Banerjee,
Duflo
,
Glennerster
, and Kothari, 2010)
Many of the programs designed to improve provider accountability have proved unsuccessful, absenteeism increases with qualifications (Kremer and
Glennerster
, 2010)
More, but less qualified, staff to give simple prevention technologies
I
ntuitive but not yet rig evidence to support this
Recruiting the right people more important than monitoring (Ashraf,
Bandiera
, and Scott)
Community report cards can help monitor disbursed health workers and improve health
(
Bonargent
,
Dube
, Haushofer, Siddiqi, 2015)Slide6
Nudge incentives to increase immunizationSlide7
Improving provider accountability is hard
7
Cost per additional day
of provider attendanceSlide8
Community monitoring: birth in a clinicSlide9
Community monitoring: illegal feesSlide10
Community monitoring: children wastedSlide11
CM: communities helping nurse with gardenSlide12
Taking lessons from one context to another
Is one rigorous evaluation
of immunization incentives enough evidence for Sierra Leone government to act?
Tested in India with an NGO
Want to scale it up in Sierra Leone with government
Much more evidence this type of approach is likely to work
Lots of practical issues to work through context specific
Slide13
What is needed for incentives to work?
Evidence on behavioral
Do basic conditions hold locally?
Local logistics critical
Impact
Small incentives offset bias
Health improvesSlide14
How do we incorporate these lessons?
Basic conditions appropriate for incentives for immunization
Need to attract patients back to clinics post Ebola
PreEbola
high rates for early vaccines but drop off
Special campaigns to boost rates are expensive
What incentive to use? What supply chain to use for delivery? How to avoid incentive being siphoned off and sold?
Community Health Workers offer promise of delivering prevention cheaply and conveniently but many questions
Can SL attract the high quality CHWs Zambia did?
How to reward them—incorporate into performance based pay?
Can Community Monitoring be incorporated in a cheap and efficient way?
14Slide15