Building Resilient Health Systems : Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak

Christensen, Darin ; Dube, Oeindrila ; Haushofer, Johannes ; Siddiqi, Bilal ; Voors, Maarten

World Bank, Washington, DC

关键词: HEALTH SYSTEM;    EBOLA OUTBREAK;    HEALTH WORKERS;    CLINIC UTILIZATION;    PATIENT SATISFACTION;   

DOI  :  10.1596/1813-9450-9223
RP-ID  :  WPS9223

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

This paper experimentally examinesefforts aimed at improving health worker performance in thecontext of the 2014-15 West African Ebola crisis. Roughlytwo years before the outbreak in Sierra Leone, the studyrandomly assigned two accountability interventions togovernment-run health clinics—one focused on communitymonitoring and the other gave status awards to clinic staff.The findings show that, prior to the Ebola crisis, bothinterventions led to improvements in utilization of clinics,patient satisfaction with the health system, and childhealth outcomes. During the crisis, the interventions led tohigher reported Ebola cases, as well as lower mortality fromEbola, particularly in areas with community monitoringclinics. The paper explores the potential mechanisms, andthe findings provide evidence consistent with the followingmechanism: by building trust and confidence in healthworkers, and improving the perceived quality of careprovided by clinics prior to the outbreak, the interventionsencouraged patients to report and receive treatment. Theresults suggest that accountability interventions not onlyhave the power to improve health systems during normaltimes, but also can make health systems resilient to crisesthat may emerge over the longer run.