Community Driven Development (CDD) is one of the most frequently advocated processes for managing and implementing (local) development programs. The CDD approach operates on the principles of participatory governance (stimulate participation by intended beneficiaries) as a mechanism to strengthen demand-responsiveness and local accountability.
This paper provides evidence of impact of the CDD approach in a context — primary health care delivery in Uganda — previously shown to be conducive to this kind of process interventions. We contrast the results of the CDD intervention with a more elaborated intervention that adds dissemination of information on what the beneficiaries should expect and are currently experiencing. The CDD intervention had little measurable impact on health workers’ performance or the quantity and quality of health care in the short and medium run, while the intervention combining information and participation showed significant improvements in both health care delivery and health outcomes after four years. Taken together, the evidence suggests that enhanced participation alone has little impact without changing the underlying informational asymmetries. Interventions that relax these informational constraints, and provide communities with a clear agenda, however, can result in large and sustained long run improvements in both health service provision and health outcomes.