Measuring the Link between Medical Effort and Patient Outcomes in a Low-Resource Health Setting

Doctors in Tanzania and most developing countries face constraints on their time, abilities and resources. As a result, the quality of care in these settings is typically low. Studies show that the average doctor in Tanzania adheres to only half of the items required by national protocol. At the same time, 100,000 children die every year in Tanzania from illnesses for which there are known and inexpensive treatment options. Not providing patients with appropriate care may play some role in this high mortality rate. Yet differences in medical quality across doctors are not independent of patient and illness characteristics. Thus, it is difficult to show that high or low quality causes good or bad outcomes. We propose to augment a current project, studying doctors in Tanzania, to collect data on patient outcomes tied to exogenous changes in quality. The currently funded study will test the size and duration of the Hawthorne effect—the fact that professionals increase effort (and therefore quality) when they are observed by peers.