Where the state is weak, traditional authorities control the local provision of public goods. These leaders come from an older, less educated generation and often rule in an authoritarian and exclusionary fashion. This means the skills of community members may not be leveraged in policymaking. We experimentally evaluate two solutions to this problem in Sierra Leone: one encourages delegation to higher-skill individuals, and a second fosters broader inclusion in decision making. In a real-world infrastructure grants competition, a public nudge to delegate led to better outcomes than the default of chiefly control, whereas attempts to boost participation were largely ineffective.

Skepticism about the quality of health systems and their consequent underuse are thought to contribute to high rates of mortality in the developing world. The perceived quality of health services may be especially critical during epidemics, when people choose whether to cooperate with response efforts and frontline health workers. Can improving the perceived quality of health care promote community health and ultimately help to contain epidemics? We leverage a field experiment in Sierra Leone to answer this question in the context of the 2014 West African Ebola crisis. Two years before the outbreak, we randomly assigned two interventions to government-run health clinics—one focused on community monitoring, and the other conferred nonfinancial awards to clinic staff. Prior to the Ebola crisis, both interventions increased clinic utilization and patient satisfaction. Community monitoring additionally improved child health, leading to 38% fewer deaths of children under age five. Later, during the crisis, the interventions also increased reporting of Ebola cases by 62%, and community monitoring significantly reduced Ebola-related deaths. Evidence on mechanisms suggests that both interventions improved the perceived quality of health care, encouraging patients to report Ebola symptoms and receive medical care. Improvements in health outcomes under community monitoring suggest that these changes partly reflect a rise in the underlying quality of administered care. Overall, our results indicate that promoting accountability not only has the power to improve health systems during normal times, but can also make them more resilient to emergent crises.

We use a series of field experiments in rural Burundi to examine the impact of exposure to conflict on social, risk, and time preferences. We find that conflict affects behavior: individuals exposed to violence display more altruistic behavior towards their neighbors, are more risk-seeking, and have higher discount rates. Large adverse shocks can thus alter savings and investments decisions, and potentially have long-run consequences—even if the shocks themselves are temporary.