As a complementary strategy, it has therefore been argued that more e¤ort must be placed on strengthening bene...ciary control, i.e. strengthening providers’accountability to citizen-clients (see e.g., World Bank, 2003). However, despite the enthusiasm for such an approach, there is little credible evidence on the impact of policy interventions aimed at achieving it (Banerjee and He, 2003; Banerjee and Du‡o, 2005). This paper attempts to provide some.

To examine whether bene...ciary control works, we designed and conducted a randomized ...eld experiment in 50 "communities" from nine districts in Uganda.<sup>4</sup> In the experiment, or intervention, communities were provided with baseline information on the status of service delivery, both in absolute terms and relative to other providers and the government standard for health service delivery. Community members were also encouraged to develop a plan that identi...ed areas of concerns in health provision, and how to address them within the existing resource envelope.

The intervention sought to relax two constraints typically faced by communities in monitoring providers: lack of access to reliable and structured information on the community’s entitlements and the status of service delivery, and inadequate local organizational capacity. Access to reliable and structured information about current status of service delivery and entitlements is critical for citizens’ability to monitor service providers. Although people know whether their own child died or not, and whether the health workers did anything to help them, they typically do not have any information on aggregate outcomes, such as how many children in their community did not survive beyond the age of 5 or where citizens, on average, seek care. Provision of information on outcomes and performance improves citizens’ability to challenge abuses of the system, since reliable quantitative information is more di¢ cult for service providers to brush aside as anecdotal, partial, or simply irrelevant. But information provision may not have any considerable impact unless there are members of the community who are willing to make use of the new information. Exerting accountability (monitoring providers) is subject to potentially large free-rider problems. Elite capture further complicates the process of holding providers accountable. By enhancing local organization capacity and encouraging the community to develop its own monitoring strategy, these constraints are sought to be relaxed.

The community-based monitoring project increased the quality and quantity of primary health care provision. One year into the program, we ...nd a signi...cant di¤erence in the weight of infants (0.17 z-scores increase) and a markedly lower number of deaths among children under ...ve (a 33 percent reduction in child deaths) in the treatment communities. Utilization (for general outpatient services) was 16 percent higher in the treatment compared to the control facilities. We also ...nd signi...cant di¤erences in the number of deliveries at treatment facilities and the use of antenatal care and family planning. Treatment practices, as expressed both in perception-based responses by households and in more quantitative indicators (immunization of children, waiting

> 4A "community" is operationalized as the households (and villages) residing in the ...ve-kilometer radius around the facility (see section 5 for details). Approximately 110,000 households (600,000 individuals) reside in these communities, of which half reside in the treatment communities.

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