LOCALIZING DEVELOPMENT: DOES PARTICIPATION WORK?
A program in Indonesia that gave block grants to villages to encourage them to improve specific health and education indicators achieved positive midline results . . . 204
after the trial period. These results were achieved with only 37 percent of newly pregnant women (8 percent of married women) ever attending the women’s meetings. Tripathy and others (2010) conducted a similar trial in Jharkhand and Orissa, two of India’s poorest states, where neonatal and maternal mortality rates are higher than the national average. In treatment villages, local facilitators were trained to support women’s groups, which met about 20 times in all over three years. Health committees were formed in both intervention and control clusters to discuss health entitlements from service providers, particularly for mothers and newborns.38 This intervention witnessed a 45 percent reduction in early neonatal deaths (0–6 days). By the third year of the trial, there was also a 57 percent reduction in moderate depression among mothers. There were no significant differences in health care–seeking behavior, but there were significant improvements in home care practices (use of safe kits, hand washing by birth attendants, boiling of threads used to tie the cord, and so forth). More infants were also exclusively breastfed at six weeks. The cost per life-year saved was about $33 ($48 with health-service strengthening activities). Although the availability of delivery kits increased in both control and intervention clusters, women’s groups generated more uptake of the kits in intervention areas. Olken, Onishi, and Wong (2011) evaluate a pilot program in Indonesia (PNPM Generasi) that provided block grants to villages to encourage investments intended to improve specific health and education indicators.39 In some communities, the grant was incentivized, in that the amount of the grant the following year was based partially on the village’s performance on each of the 12 targeted health and education indicators. The performance bonus was competitively allocated among villages within the same subdistrict. For the evaluation, program villages were randomly assigned to receive either the incentivized or the nonincentivized grant. The data come from three survey waves, conducted between 2007 and 2010. The study finds that the program reached beneficiaries and had very significant effects on a range of intermediate behaviors, at both midline and endline. For health, the strongest intermediate impacts were on growth monitoring and the distribution of iron sachets to pregnant women. The intervention was also associated with a 9.6 percent reduction in malnutrition and a significant increase in prenatal visits and immunizations. Health impacts were also larger in incentivized areas.