Civil wars divide nations along social, economic, and political cleavages, often pitting one neighbor against another. To restore social cohesion, many countries undertake truth and reconciliation efforts. We examined the consequences of one such effort in Sierra Leone, designed and implemented by a Sierra Leonean nongovernmental organization called Fambul Tok. As a part of this effort, community-level forums are set up in which victims detail war atrocities, and perpetrators confess to war crimes. We used random assignment to study its impact across 200 villages, drawing on data from 2383 individuals. We found that reconciliation had both positive and negative consequences. It led to greater forgiveness of perpetrators and strengthened social capital: Social networks were larger, and people contributed more to public goods in treated villages. However, these benefits came at a substantial cost: The reconciliation treatment also worsened psychological health, increasing depression, anxiety, and posttraumatic stress disorder in these same villages. For a subset of villages, we measured outcomes both 9 months and 31 months after the intervention. These results show that the effects, both positive and negative, persisted into the longer time horizon. Our findings suggest that policy-makers need to restructure reconciliation processes in ways that reduce their negative psychological costs while retaining their positive societal benefits.
The International Initiative for Impact Evaluation (3ie) promotes evidence-informed equitable, inclusive and sustainable development. We support the generation and effective use of high-quality evidence to inform decision-making and improve the lives of people living in poverty in low-and middle-income countries. We provide guidance and support to produce, synthesise and quality-assure evidence of what works, for whom, how, why and at what cost. 3ie impact evaluations 3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report 3ie accepted the final version of the report, In search of the holy grail: can unconditional cash transfers graduate households out of poverty in Zambia?, as partial fulfilment of requirements under grant DPW1.1042 awarded through Development Priorities Window Grail An object or goal that is sought after for its great significance.-Meriam-Webster Dictionary A thing which is eagerly pursued or sought after.-Oxford English Dictionary iii Contents Acknowledgements .
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 Africa 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 percent fewer deaths of children under five. Later, during the crisis, the interventions also increased reporting of Ebola cases by 62 percent, 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.
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