As reported in table 2 (regressions 1-2), one year into the project, treatment facilities are signi...cantly more likely to have suggestion boxes (no control facility had these, while 36 % of the treatment facilities did) and numbered waiting cards (only one control facility had these, while 25 % of the treatment facilities did). A higher share of treatment facilities also post information on free-services and patient’s rights and obligations (regressions 3-4). The enumerators could visually con...rm that 70 percent (17 out of 25) of the treatment facilities had at least one of these "monitoring tools" (suggestion boxes, numbered waiting cards, and/or posters on free-services), while only 4 out of 25 control units had at least one of them. The di¤erence is statistically highly signi...cant (column 5).

The results based on household data mirror the ...ndings reported in columns 1-5. For example, the performance of the sta¤ is more often discussed in local council meetings in the treatment communities (regression 6), suggesting that the treatment communities became more engaged. Three out of four households surveyed have attended at least one village meeting in 2005. Of those attending, 40 percent (13 percentage points) more households in the treatment community report that the functioning of the health facility was discussed. Combining the evidence from the CBO reports and the household survey data thus suggests that both the "quantity" of discussions about the project facility and the subject (from general to speci...c discussions about the community contract) changed in response to the intervention.<sup>19</sup>

# 7.3 Treatment practices

The qualitative evidence from the CBOs and, to the extent that we can measure it, the ...ndings reported in table 2, con...rm that the treatment communities became more involved in monitoring the provider. Did community monitoring a¤ect the health worker’s behavior and performance? We turn to this next. We report the results on treatment practices and sta¤ behavior, both as expressed in perception responses by households (in appendix A.3) and in quantitative indicators such as the immunization of children, waiting time, sta¤ absenteeism, examination procedures, management of the clinic, and extent of preventive care.

We start by looking at examination procedures.<sup>20</sup> Regression 1, table 3, presents the result of estimating (4) with the dependent variable being an indicator of whether any equipment (for instance thermometer or blood pressure equipment) was used during the examination. 49 percent of the patients in the treatment community reported that equipment was used the last time the respondent (or the respondent’s child)

> 19Additional evidence on community engagement and monitoring is reported in appendix A.3.

> 20Naturally, the relevant treatment is conditional on illness and the condition of the patient. However, since the project was randomly allocated across communities, there is no reason to believe that the type of illness and the condition of the patients should di¤er systematically across groups. In fact, we have information on reported symptoms for which the patient seeks care (from the household survey). There are, on average, no systematic di¤erences in reported symptoms across treatment and control communities.

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