Health Service Delivery and Political Trust in Nigeria

• In Event: Trust and Regime Influences on Health and Healthcare

Abstract

Do improvements in health service delivery affect trust in political leaders in Africa? Citizens expect their government to provide social services. Intuitively, improvements in service delivery should lead to higher levels of trust in and support for political leaders. However, in contexts where inadequate services are the norm, and where political support is linked to ethnic or religious affiliation, there may be weak linkages between improvements in service delivery and changes in trust in political leaders. To examine this question empirically, we take advantage of a national intervention that improved service delivery in 500 primary health care facilities in Nigeria, to estimate the impact of residence within 10 kilometers of one or more of the intervention facilities on trust in the President, local councils, the ruling party, and opposition parties. Using a difference-in-difference design, we show that proximity to the intervention led to increases in trust in the President, and in the ruling party. By contrast we find no evidence of increased trust in the local council, or in opposition parties. Our study also examines role for ethnicity and religious affiliation in mediating the observed increases in trust in the President. While there is a large literature suggesting that both the targeting of interventions, and the response of citizens to interventions are mediated by ethnic, geographic or religious identity in African countries, by contrast, we find no evidence that the intervention was targeted at the president’s ethnic group, zone, or state of origin. Moreover, there is suggestive evidence that the intervention increased trust in the president more among those who did not share these markers of identity with the president. This highlights the possibility that broad-based efforts to improve health service can increase trust political leaders even in settings where political attitudes are often thought to be mediated by group identity.

Authors

• Kevin Croke, Harvard School of Public Health

• Adanna Chukwuma, Harvard University

• Thomas J. Bossert, Harvard University