Josh Greenberg, MD, PhD
Nominated From: University of Michigan
Research Site: Davi
Research Area: Governance and accountability in health service provision
Primary Mentors: Dr. Joseph Kolars, Dr. Fred Muhumuza,
Research Project
Governance, Citizenship, and Accountability: Taking Community-Centered Development in the Ugandan Health Sector to Scale
Widespread accountability gaps in the public health sectors of low- and middle-income countries account for many government failures to deliver available, affordable health interventions. In Uganda, local political leaders have the potential to mitigate accountability problems by monitoring service provision at government health centers — but few do so. Limited citizen-politician information flow and inadequate politician training may explain this observation. My research as a Fogarty Fellow aims to address such constraints to quality healthcare delivery with two governance interventions: (a) quarterly reporting meetings between citizens and local politicians to address health service delivery and (b) health leadership capacity-building to enable local politicians to monitor health facilities more effectively. Building on a recent pilot trial I carried out that provided proof-of-concept for these two programs, I will use the fellowship period to transform the former feasibility study into a full-scale evaluation. The evaluation will be one of a few to examine programs directly targeting political economy inefficiencies in health service provision.
Research Significance
Many studies in the health and development fields focus on the introduction of novel, externally supported interventions implemented in laboratory-like settings; but the scale-up of these interventions into national programs is often limited by the background institutional context. With potentially broad implications, my research instead directly targets institutional quality, which likely has pervasive effects across multiple public service sectors. Most of all, the approach focuses on using existing resources more efficiently and may be an especially promising strategy for development. At a time when trust in public institutions has emerged as a critical ingredient for public health, the grassroots nature of my work offers important insights for efforts aimed at rejuvenating health systems in countries around the world.
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