health systems (Alsan and Wanamaker 2017; Blair et al. 2017; Vinck et al. 2019; Lowes and Montero 2018). As such, accountability interventions may confer particularly large benefits during crisis conditions, through their effects on reporting and cooperation, which can help reduce mortality and the spread of an epidemic.

To the best of our knowledge, we present the first experimental evidence showing this potential benefit, by demonstrating how accountability interventions can improve improve perceptions of the health system, increase epidemic reporting, and lower mortality conditional on reporting during a crisis. In this regard, our findings shed light on how accountability interventions can make health systems more resilient to major disruptions such as a health crisis.<sup>6</sup> Other evaluations of social accountability programs may miss this potential benefit given the infrequency of crises events.

More broadly, our findings bear on a larger literature on how to increase accountability among frontline bureaucrats and improve public services. The effects we observe do not align with net crowd-out of intrinsic motivation. Instead, they are consistent with previous work suggesting that social incentives such as nonfinancial awards can be used to boost worker performance in mission-oriented settings (Ashraf et al. 2014), as well as other experimental settings (Kosfeld and Neckermann 2011) and the private sector (Markham et al. 2002). Empowering citizens through community monitoring has also been examined as a tool for improving service delivery in a variety of social sectors, including education (Banerjee et al. 2010; Pradhan et al. 2011; Barr et al. 2012; Andrabi et al. 2018), corruption (Fiala and Premand 2018; Olken 2007) and health. As discussed above, our results align closely with Björkman and Svensson (2009), but are further from the more recent work of Raffler et al. (2019) who also examine community monitoring of health clinics in Uganda, but find weak effects. A possible reason for these contrasting results may lie in the baseline health conditions under which the interventions were implemented. The Björkman and Svensson (2009) intervention was implemented in 2004-2005, when under-5 mortality in Uganda stood at 117 per 1,000 live births. Analogously, our accountability interventions in Sierra Leone were implemented when under-5 mortality stood at 149.8 per 1,000 live births. In contrast, the more recent study in Uganda implemented community monitoring over 2014-2016, when infant mortality had fallen to 59 per 1,000 live births. The lack of consistent effects in the latter context suggest that it may be more difficult to improve health outcomes when baseline conditions themselves have already improved substantially (Raffler et al. 2019).<sup>7</sup> The interventions we analyze harness social accountability and competition between providers to improve interactions between providers and the communities they serve. Other related approaches to improving health service delivery have examined the effects of financial incentives (Miller et al. 2012; Olken et al. 2014; Singh and Mitra 2017); combined technological monitoring with financial incentives (Banerjee et al.

> 6 Relatedly, Bandiera et al. (2019) find that an empowerment program for young women in Sierra Leone increases their capacity to cope with disruptions caused by the Ebola crisis.

> 7 When implemented under challenging baseline conditions, the effects of community monitoring appear to persist. A follow-up study of the original Björkman and Svensson (2009) intervention suggests a lack of convergence in health outcomes up to four years later (Björkman Nyqvist et al. 2017).

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