Abstract
AbstractWe used a randomized management consulting intervention with 80 public‐sector healthcare facilities in Nigeria to study the role of information, training, and supervision on the adoption of improved organizational practices. Facilities that received detailed improvement plans and 9 months of implementation support—including regular visits to monitor progress and set intermediate goals related to the plans—showed large, significant short‐term effects on the adoption of practices that were under the responsibility of facility staff. Facilities that received general improvement advice but no implementation support showed no change in practices. Implementation support appears crucial for improvements, especially in contexts without market incentives for the adoption of effective managerial practices.
Highlights
Can organizations improve their managerial and organizational practices without increasing the recurrent resources employed? If so, how? We examine these questions with a randomized controlled trial of a management consulting intervention conducted in primary, public-sector healthcare centers in Nigeria.In recent years, improving the quality of healthcare provision—beyond merely making it available—has become a higher priority for the World Health Organization (WHO) and other health agencies (WHO 2006; Institute of Medicine, 2001; Das et al 2008)
We present results from a randomized field experiment conducted in partnership with the Nigerian Federal Ministry of Health (FMOH) to evaluate the effects of a healthcare management consulting program for public primary health centers (PHCs) in six Nigerian states
The goal of the SafeCare program was to assist the PHCs in adopting a set of organizational practices
Summary
Can organizations improve their managerial and organizational practices without increasing the recurrent resources employed? A recent and growing literature suggests that managerial and organizational practices matter greatly for organizational productivity and outcomes (Bloom, Sadun & Van Reenen 2012; Bloom et al 2013), including in the healthcare sector (Bloom et al 2020), and that differences in management practices across organizations and countries account for a large share of the dispersion in productivity not explained by the quantity and quality of the inputs used. Increasing the quantity of inputs may not translate into improved quality of healthcare: Das and Hammer (2014) find “no correlation between structural inputs and practice quality” across a number of studies, and Das et al (2012) find that differences in levels of medical training of caregivers account for small or no differences in the quality of provided care. Improving the management of health facilities holds the promise of improving the quality of care and increasing the returns to other inputs
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