more than 4km from the centroid of its assigned market, with the centroid computed recursively from the location of all facilities mapped to the market. The 4km radius was based on data from the baseline, which showed that 73% of patients lived within 4km of the health facility. This algorithm yielded a total of 273 markets of which 30% had one facility, 28% had 2-3 and 42% had 4 or more (Figure S2 in the Supplemental Material shows mapped examples of each type of market). This distribution also implies, as discussed previously, that 79% of facilities are located in markets with 4 or more providers, and 70% of care is sought in such markets.

**Allocation of treatments** : Having defined markets, we used a stratified cluster randomized experimental design to allocate markets to treatments. Clusters are healthcare markets and the cluster size is the number of health facilities per market. We stratify by market size and county for a total of 16 strata.<sup>15</sup> All 273 markets were randomly allocated to one of three arms:<sup>16</sup>

1. The Inspection Only or T1 Arm: 90 markets were assigned to high-intensity inspections with enforcement of warnings and sanctions for non-compliant facilities.

2. The Inspections plus Information or T2 Arm: 96 markets were assigned to the T2 arm, which combines the T1 arm with the public disclosure of inspection results.

3. Control Group: 87 markets were assigned to the “business-as-usual” low-probability inspections arm. Although inspections could have been carried out if there was a serious complaint, in practice, there were no joint inspections in the year of the intervention.

The scorecard system in T2 consisted of 4 letter grades ranging from A (fully compliant, or more than 75% or the maximum score) to D (minimally compliant, or 11%-40%). See Panel A in Figure A1 of the Appendix. After each inspection, the inspector posted the scorecard in a prominent area, such as the patient waiting area, together with an explanatory poster (Panel A, Figure A2). In additional visits to all health facilities, quality officers distributed 65,000 flyers explaining the inspection results to community members, patients and other residents in the market areas (Panel B of Figure A2).

In cases where a facility was marked for closure (whether in T1 or T2) an additional red closure scorecard was posted at the facility or department during visits by the national team and county health officials (Panel B in Figure A1 of the Appendix). Closure events often led to extended discussions with the in-charge and people from the catchment area, where the government explained the reasons for the closure and why this was important for the population. The team also provided in-charges with information about the licensing process.

> 15We have 5 strata by market size for markets with 1, 2, 3, 4-10, and 11+ health facilities for the 3 counties, and an additional stratum for market size 34 or more (extreme values) in Meru for a total of 16 strata.

> 16Section 5 of the Supplemental Material includes tables presenting baseline and endline surveys (Table S3), the census of health facilities (Table S4), and details by treatment arm and county at randomization and endline (Table S5).

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