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Title The Political Economy of NGO Service Delivery: Evidence from a Downstream Field Experiment in Uganda
Post date 10/17/2018
C1 Background and Explanation of Rationale Since the 1990s, the presence of NGOs in the developing world has undergone explosive growth, due in large part to sharp increases in international aid and philanthropy received by these organizations. While analyses of specific interventions implemented by NGOs are common, less work has been done to investigate the possible downstream effects that these organizations have on domestic politics. Research on the “fiscal link” between citizens and states and concerns expressed by practitioners on the ground suggest that NGO service delivery could undermine the incentives that drive citizens to be politically engaged. However, recent work on political credit attribution suggests that government actors often receive credit for policies and programs that they are not responsible for. I theorize that the effect of non-state service delivery on engagement is conditioned by credit attribution. To test this theory, this project leverages a large, highly effective, randomized NGO-implemented community health worker intervention in Uganda by surveying 1,600 households across 165 villages that participated the trial This field experiment --- conducted downstream from a large and highly effective cluster-randomized community health worker intervention in Uganda --- will identify the long-term effects of an NGO service delivery program that provided treated communities with a substitute for a similar government health service. The findings will have implications for our understanding of how service delivery conditions state-society relations and for development aid policy, effective philanthropy practices, and social policy in developing countries.
C2 What are the hypotheses to be tested?

According to existing theories of political development, the availability of substitutes for state provided public services should reduce individual propensity to be engaged with politics. However, I argue that the effect of substitutes for state services on engagement is likely to be conditioned by contextual factors, specifically, how citizens assign credit for these services. If citizens attribute credit for an NGO provided service to the NGO exclusively, the proliferation of NGO services may depress political engagement. Alternatively, if citizens attribute credit to government actors for the production, distribution, or welfare effects of NGO services, the proliferation of these services may cause citizens to positively update their beliefs about government responsiveness or state capacity, increasing the expected returns to political engagement.

In turn, higher levels of engagement in communities that receive NGO projects may cause governments to make complementary investments by increasing access to government services in these communities. However, improved perceptions of government performance or increased support for incumbent politicians resulting from credit attribution are likely to offset pressure from increased engagement.

This project will measure the impact of the CHP intervention on one primary outcome--- political engagement -- -and five secondary outcomes that I expect to condition the effect of the intervention on political engagement: credit attribution, perceptions of government responsiveness, perceptions of state capacity, expectations of government, and complementary investments. In addition to these outcomes of interest, I will also investigate several alternative mechanisms and explanations, including policy priorities, substitution, provider salience, deprivation, levels of trust, and social capital.

C3 How will these hypotheses be tested? *

To address these questions, I leverage random assignment of villages in Uganda to receive a large NGO health program that operated parallel to a comparable government program. In 2001, the Ugandan government adopted a community health worker (CHW) strategy. Volunteers are recruited to form Village Health Teams (VHT) that receive training according to guidelines established by the Ministry of Health and are overseen by nearby government health facilities. Living Goods is an international NGO that uses an innovative CHW program to increase access to basic health. While government VHTs and the LG Community Health Promoters (CHPs) program are designed with similar objectives, CHPs are equipped with superior training and offer a wider array of health-related goods and services.

Between 2011 and 2014, Living Goods carried out a cluster-randomized trial in 214 villages (115 treatment and 99 control) encompassing more than 50,000 households in 10 districts across Uganda. Nyqvist et al. (2018) used a cross-sectional survey of 8,119 households to measure the effect of the program, finding a 27% reduction in child mortality in treatment villages. Using an original cross-sectional survey including two behavioral measures, this project will measure the impact of the intervention on a political economy outcomes not considered by the original evaluation. Village-level data will be collected from interviews with local government officials (LC1, VHT) in each village documenting NGO activity and government investments in service delivery and infrastructure. This village-level data will be used to assess whether treatment villages receive complementary investments in service delivery at higher (or lower) levels than control villages.

C4 Country Uganda
C5 Scale (# of Units) 1,600 respondents in 165 villages
C6 Was a power analysis conducted prior to data collection? Yes
C7 Has this research received Insitutional Review Board (IRB) or ethics committee approval? Yes
C8 IRB Number Mildmay Uganda Research and Ethics Committee (REF 0410-2017); University of Pennsylvania Institutional Review Board (REF 828451); Uganda National Council for Science and Technology (SS170ES)
C9 Date of IRB Approval 2/05/2018; 3/08/2018; 6/26/2018
C10 Will the intervention be implemented by the researcher or a third party? Living Goods Uganda/ BRAC Uganda
C11 Did any of the research team receive remuneration from the implementing agency for taking part in this research? not provided by authors
C12 If relevant, is there an advance agreement with the implementation group that all results can be published? Yes
C13 JEL Classification(s) not provided by authors