Person:

Levy, Dan

This baseline report describes the baseline data collection activities, baseline findings and revised primary outcomes for the impact evaluation of phase one of the Transparency for Development (T4D) project.

The report is broken into five chapters. Chapter I describes the T4D intervention and evaluation, and situates the project within the broader context of the fields of transparency and accountability (T/A) and maternal and neonatal health (MNH). Chapter II describes the T4D data collection process, including a description of the survey tools, sampling strategy, and how data were cleaned and prepared. Chapter III presents the baseline findings for the T4D communities in Indonesia and Tanzania. It also describes how these findings were used to revise the evaluation design. Chapter IV details the T4D impact evaluation design. This chapter includes details on random assignment and verification of balance on observable variables between treatment and control villages, a listing of primary outcomes by research question, and the T4D impact estimation strategy. Finally, chapter V presents conclusions and next steps.

This chapter is organized as follows: Section 1 describes the current state of MNH worldwide, and in Tanzania and Indonesia specifically. It explores the use of transparency and accountability (T/A) interventions to improve MNH and positions the T4D project within this debate. Section 2 provides a detailed description of the T4D intervention, including its underlying logic model. Section 3 describes the T4D evaluation, in which the impact evaluation (the primary topic of this report) plays a major role.

The Transparency for Development Evaluation Design Report describes the mixed methods evaluation design for the Transparency for Development project as of February 2015 – just before the start of the first data collection activities associated with the project (baseline data collection in Indonesia).

Since the writing of this report, a number of changes have been made to the design. For the most recent details, visit t4dproject.org.

We assess the impact of a transparency and accountability program designed to improve maternal and newborn health (MNH) outcomes in Indonesia and Tanzania. Co-designed with local partner organizations to be community-led and non-prescriptive, the program sought to encourage community participation to address local barriers in access to high quality care for pregnant women and infants. We evaluate the impact of this program through randomized controlled trials (RCTs), involving 100 treatment and 100 control communities in each country. We find that on average, this program did not have a statistically significant impact on the use or content of maternal and newborn health services, nor the sense of civic efficacy or civic participation among recent mothers in the communities who were offered it. These findings hold in both countries and in a set of prespecified subgroups. To identify reasons for the lack of impacts, we use a mixed-method approach combining interviews, observations, surveys, focus groups, and ethnographic studies that together provide an in-depth assessment of the complex causal paths linking participation in the program to improvements in MNH outcomes. Although participation in program meetings was substantial and sustained in most communities, and most attempted at least some of what they had planned, only a minority achieved tangible improvements and fewer still saw more than one such success. Our assessment is that the main explanation for the lack of impact is that few communities were able to traverse the complex causal paths from planning actions to accomplishing tangible improvements in their access to quality health care.