Information and Facilitation Interventions for Accountability in Health and Nutrition: Evidence from a Randomized Trial in India

Community-based accountability interventions have shown potential to improve delivery of public services, but there is limited evidence on the effectiveness of such interventions when implemented at scale by developing country governments. We study the effectiveness of social accountability interventions implemented by the Indian state government of Uttar Pradesh aimed at improving delivery of primary health and nutrition services to children and pregnant women. Using a village level randomized trial design, we investigate two key mechanisms through which accountability interventions are hypothesized to improve healthcare delivery and health outcomes: information provision about health service entitlements and facilitation of collective action for community monitoring. We find large improvements in immunization rates, treatment of childhood diarrhea, and institutional delivery rates, modest improvements in child nutritional outcomes, and no effects on child mortality. Overall, the effects of information combined with facilitation are larger and statistically significant more often than that of providing information alone. We also find evidence of gender disparities with most of the average effects being driven by improvements among boys, with little to no effect of accountability interventions among girls.