Strengthening state capacity in health: Building demand for government services and accurate data on utilisation.

Ebola deterred Sierra Leoneans from accessing healthcare and undermined citizens’ trust in government services. The number of children vaccinated with Pentavalent 3 declined by 17% (Ministry of Health and Sanitation (MoHS) Sierra Leone, UNICEF, 2015). The Government of Sierra Leone, together with development partners is heavily investing in strengthening health services however there is a shortage of information on cost-effective ways to do this in a state with weak capacity. To contain Ebola and encourage citizens to return to clinics, community engagement has proven critical (MoHS, UNICEF Sierra Leone, 2015). This project will evaluate social incentives, in the form of coloured bracelets for children, to encourage caregivers to vaccinate their children and rebuild trust between communities and health workers. The bracelets make it highly visible that community members use formal health services and immunise their children, which could encourage others to utilize public health services, particularly for immunisation.

Delivering public services in low populated rural areas poses a challenge to governments to remain at low cost. Thus, targeting four districts with low immunisation rates, including Kambia, Bombali, Tonkolili, and Western Area Rural, the project looks at a low-cost incentive mechanism to increase service utilisation. The bracelets are less expensive than consumption incentives, and are simpler to distribute due to their small size and lower leakage potential. The evaluation will examine whether small social incentives can encourage households to travel further distances to receive immunisations.

In addition, within the scope of strengthening state capacity in public healthcare, the project aims to assess the accuracy of different administrative data and provide insights on how data capture can be improved. Crucial to state strengthening are systems, which enable governments to make informed spending decisions and identify weaknesses in service provision. The Government’s post-Ebola efforts are severely compromised by a lack of accurate data. The main Ministry of Health and Sanitation data sources (for child health) show severe discrepancies and do not match trusted survey data sources. It is unclear what are reliable data sources. What is clear is that administrative data can provide comprehensive and frequent information from clinics at a much lower cost than survey data can.

This project will digitise clinic records, collect household data to approximate error rates, while increasing monitoring and incentivising accurate data capture at clinic level.