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Building Resilient Health Systems: Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak
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Year: 2020 Publisher: Washington D.C. Center for Global Development

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African states since independence
Authors: ---
ISBN: 0300244940 0300226616 9780300244946 9780300226614 Year: 2019 Publisher: New Haven

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Authors Christensen and Laitin argue that an interplay of geographic, historical, and demographic factors undergird sub-Saharan states' post-independence struggles to eradicate poverty, establish democratic accountability, and quell civil unrest. They set out the founding fathers' challenges in transforming their postcolonial states, many of which are ethnically diverse, geographically diffuse, sparsely populated, and lacking in administrative capacity. With the legacies of the slave trade, partition, Christian missionaries, and extractive colonial institutions complicating their efforts, many African states faced stagnation, authoritarianism, and civil strife. Recent years have seen promising attempts to restore democracy to states under authoritarian rule and to liberalize their economies, suggesting that the region is moving toward a new era. Relying on the best statistical data and richly illustrated with case material, this book is an indispensable source for scholars and policy analysts seeking to understand Africa's post-independence political trajectories.


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Building Resilient Health Systems : Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak
Authors: --- --- --- --- --- et al.
Year: 2020 Publisher: Washington, D.C. : The World Bank,

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This paper experimentally examines efforts aimed at improving health worker performance in the context of the 2014-15 West African Ebola crisis. Roughly two years before the outbreak in Sierra Leone, the study randomly assigned two accountability interventions to government-run health clinics-one focused on community monitoring and the other gave status awards to clinic staff. The findings show that, prior to the Ebola crisis, both interventions led to improvements in utilization of clinics, patient satisfaction with the health system, and child health outcomes. During the crisis, the interventions led to higher reported Ebola cases, as well as lower mortality from Ebola, particularly in areas with community monitoring clinics. The paper explores the potential mechanisms, and the findings provide evidence consistent with the following mechanism: by building trust and confidence in health workers, and improving the perceived quality of care provided by clinics prior to the outbreak, the interventions encouraged patients to report and receive treatment. The results suggest that accountability interventions not only have the power to improve health systems during normal times, but also can make health systems resilient to crises that may emerge over the longer run.

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