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Management Practices and Quality of Care: Evidence from the Private Health Care Sector in Tanzania

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  • Timothy Powell-Jackson
  • Jessica J C King
  • Christina Makungu
  • Matthew Quaife
  • Catherine Goodman

Abstract

We measure the adoption of management practices in over 220 private for-profit and non-profit health facilities in 64 districts across Tanzania and link these data to process quality-of-care metrics, assessed using undercover standardised patients and clinical observations. We find that better managed health facilities are more likely to provide correct treatment in accordance with national treatment guidelines, adhere to a checklist of essential questions and examinations, and comply with infection prevention and control practices. Moving from the 10th to the 90th percentile in the management practice score is associated with a 48% increase in correct treatment. We then leverage a large-scale field experiment of an internationally recognised management support intervention in which health facilities are assessed against comprehensive standards, given an individually tailored quality improvement plan and supported through training and mentoring visits. We find zero to small effects on management scores, suggesting that improving management practices in this setting may be challenging.

Suggested Citation

  • Timothy Powell-Jackson & Jessica J C King & Christina Makungu & Matthew Quaife & Catherine Goodman, 2023. "Management Practices and Quality of Care: Evidence from the Private Health Care Sector in Tanzania," The Economic Journal, Royal Economic Society, vol. 134(657), pages 436-456.
    • Handle: RePEc:oup:econjl:v:134:y:2023:i:657:p:436-456.
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    References listed on IDEAS

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    1. Daniela Scur & Raffaella Sadun & John Van Reenen & Renata Lemos & Nicholas Bloom, 2021. "The World Management Survey at 18: lessons and the way forward," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 37(2), pages 231-258.
    2. Sima Berendes & Peter Heywood & Sandy Oliver & Paul Garner, 2011. "Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies," PLOS Medicine, Public Library of Science, vol. 8(4), pages 1-10, April.
    3. Leonard, Kenneth L. & Masatu, Melkiory C., 2010. "Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance," Journal of Development Economics, Elsevier, vol. 93(2), pages 226-234, November.
    4. Elizabeth H Bradley & Patrick Byam & Rachelle Alpern & Jennifer W Thompson & Abraham Zerihun & Yigeremu Abeb & Leslie A Curry, 2012. "A Systems Approach to Improving Rural Care in Ethiopia," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-7, April.
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