Essays on Health, Human Rights, and Social Development

Abstract

Spanning diverse perspectives, the five chapters of this dissertation relate to health, human rights, and social development. Broadly speaking, the first two chapters center on the supply side of healthcare provision in Uganda, while the third chapter, also situated in Uganda, focuses on demand-side barriers to health. Complementing this work on healthcare delivery and health behavior, Chapter 4 builds on the role of health in human capital formation. Finally, Chapter 5 zooms out from the research questions of Chapters 1-4 to present key observations about the development sector.

Specifically, Chapter 1 focuses on citizen participation, which is considered a key priority in making public service delivery more accountable. I conduct a randomized controlled trial to evaluate the effect of differently themed messages encouraging households to attend community meetings that address local healthcare quality. I find that receiving a message — of any type — significantly increases meeting participation, but that the specific type of message does not appear to induce any further effects. The results provide important evidence on how to better foster democratic engagement.

Building on this work, Chapter 2 addresses the widespread accountability gaps in the public health sectors of low- and middle-income countries. Focusing on the role of political leaders in promoting improved health sector performance, I present the results of a pilot study of the following interventions: (a) citizen reporting meetings with local politicians on health service delivery and (b) politician skills training on monitoring local government health centers. The study is one of a few to evaluate programs directly targeting political economy inefficiencies. Both interventions achieve substantial stakeholder engagement, laying the groundwork for an at-scale evaluation.

Using a difference-in-differences design, Chapter 3 evaluates a community health worker program aimed at improving maternal health. I find relatively little evidence of an overall program effect on health behaviors, although heterogeneity analysis provides suggestive evidence of treatment effects. In contrast to these weak findings, I find large improvements in healthcare-seeking behavior between the pre- and post-intervention periods. Altogether, the study helps to fill a key evidence gap on a common intervention.

Chapter 4 turns to an under-recognized pathway through which mass incarceration may affect social welfare: by burdening young Black men with substantial expectations of future incarceration and thereby altering their life decisions before they even experience any imprisonment. Together with Hoyt Bleakley, I mathematically model and empirically quantify the effects of excess incarceration and mortality on educational choice across Black and White men in the U.S. We find that this future expectations pathway explains most, if not all, of the persistent racial education gap in men. This finding has significant implications for policies aimed at addressing racial disparities in education.

Lastly, drawing on the dissertation’s running theme of quality, Chapter 5 builds an intellectual framework for quality production in the development sector. In the context of development, quality is an especially complicated object for two reasons: (1) the very attempt to measure quality often undermines quality; (2) efforts to properly define quality at a product level may be infeasible. Based on these observations, I demonstrate the importance of a more upstream perspective in assessing quality in the development industry. In doing so, I establish a mathematical model of production cycle quality, while also elucidating the roles of selection and institutions in promoting quality in the aid sector.