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Management, Supervision, and Health Care: A Field Experiment

Author

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  • Dunsch, Felipe A.

    (World Bank)

  • Evans, David K.

    (Center for Global Development)

  • Eze-Ajoku, Ezinne

    (Johns Hopkins University)

  • Macis, Mario

    (The Johns Hopkins Carey Business School)

Abstract

If health service delivery is poorly managed, then increases in inputs or ability may not translate into gains in quality. However, little is known about how to increase managerial capital to generate persistent improvements in quality. We present results from a randomized field experiment in 80 primary health care centers (PHCs) in Nigeria to evaluate the effects of a health care management consulting intervention. One set of PHCs received a detailed improvement plan and nine months of implementation support (full intervention), another set received only a general training session, an overall assessment and a report with improvement advice (light intervention), and a third set of facilities served as a control group. In the short term, the full intervention had large and significant effects on the adoption of several practices under the direct control of the PHC staff, as well as some intermediate outcomes. Virtually no effects remained one year after the intervention concluded. The light intervention showed no consistent effects at either point. We conclude that sustained supervision is crucial for achieving persistent improvements in contexts where the lack of external competition fails to create incentives for the adoption of effective managerial practices.

Suggested Citation

  • Dunsch, Felipe A. & Evans, David K. & Eze-Ajoku, Ezinne & Macis, Mario, 2017. "Management, Supervision, and Health Care: A Field Experiment," IZA Discussion Papers 10967, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp10967
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    2. 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.
    3. Harris, Donna & Borcan , Oana & Serra, Danila & Telli, Henry & Schettini, Bruno & Dercon, Stefan, 2024. "Proud to Belong: The Impact of Ethics Training on Police Officers in Ghana," CEPR Discussion Papers 19141, C.E.P.R. Discussion Papers.
    4. Erlyn K Macarayan & Hannah L Ratcliffe & Easmon Otupiri & Lisa R Hirschhorn & Kate Miller & Stuart R Lipsitz & Atul A Gawande & Asaf Bitton, 2019. "Facility management associated with improved primary health care outcomes in Ghana," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-19, July.
    5. Donna Harris & Oana Borcan & Danila Serra & Henry Telli & Bruno Schettini & Stefan Dercon, 2022. "Proud to belong: The impact of ethics training on police officers," CSAE Working Paper Series 2022-05, Centre for the Study of African Economies, University of Oxford.
    6. Dunsch, Felipe Alexander & Velenyi, Edit, 2019. "Job Preferences of Frontline Health Workers in Ghana - A Discrete Choice Experiment," SocArXiv bqx5k, Center for Open Science.
    7. Shamma Adeeb Alam & Bijetri Bose, 2022. "Stepping into adulthood during a recession: Did job losses during the Great Recession impact health of young adults?," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1730-1751, August.
    8. Sandra G. Sosa-Rubí & Sergio Bautista-Arredondo & Carlos Chivardi-Moreno & David Contreras-Loya & Gina Hera-Fuentes & Marjorie Opuni, 2021. "Efficiency, quality, and management practices in health facilities providing outpatient HIV services in Kenya, Nigeria, Rwanda, South Africa and Zambia," Health Care Management Science, Springer, vol. 24(1), pages 41-54, March.
    9. Gauri, Varun & Jamison, Julian C. & Mazar, Nina & Ozier, Owen, 2021. "Motivating bureaucrats through social recognition: External validity—A tale of two states," Organizational Behavior and Human Decision Processes, Elsevier, vol. 163(C), pages 117-131.
    10. Gauri, Varun & Jamison, Julian C. & Mazar, Nina & Ozier, Owen, 2019. "Motivating Bureaucrats through Social Recognition: External Validity — A Tale of Two States," IZA Discussion Papers 12251, Institute of Labor Economics (IZA).

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    More about this item

    Keywords

    management; health care; supervision; economic development;
    All these keywords.

    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • M10 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Business Administration - - - General
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration

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