Management, Supervision, and Health Care: A Field Experiment
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.
The intervention evaluated in this study is the result of a collaboration between the Nigerian Federal Ministry of Health, Nigerian National Primary Healthcare Development Agency (formerly known as the Saving One Million Lives initiative), and the World Bank. We gratefully acknowledge the invaluable support of Marcus Holmlund, Arianna Legovini, Marie Francoise Marie-Nelly, Kelechi Ohiri, Ado J.G Muhammad, Muhammad Ali Pate, and Hong Wang. We are also grateful to Oyebanji Filani, Giacomo de Giorgi, Benjamin Loevinsohn, Oluwole Odutolu, and participants in various conferences and seminars for helpful comments. We thank Ayodele Fashogbon for field coordination and Qiao Wang for research assistance. The research protocol was reviewed and approved by Nigeria's National Health Research Ethics Committee and the Homewood Institutional Review Board of Johns Hopkins University. This study was made possible through generous funding from the Bill and Melinda Gates Foundation. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.