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Abstract

We study whether selecting informal leaders to diffuse new clinical knowledge among peers improves healthcare and decrease maternal mortality. The setting is the Obstetric Triage Implementation Package (OTIP), a new protocol introduced among midwives in public hospitals in Ghana, where selected "Champions'' are tasked with training their colleagues. 

Exploiting OTIP's national scale-up and an arbitrary eligibility threshold, we estimate that introducing OTIP reduced institutional maternal mortality by approximately 60% among hospitals. In a field experiment conducted in a sub-set of hospitals, we randomise the rollout of the intervention and cross-randomise how Champions are selected: by management appointment or peer election. OTIP substantially increases midwives' clinical knowledge, mostly among midwives who are more central in workplace networks and who have multiple direct ties to Champions. 

Peer election further increases clinical knowledge relative to managerial appointment. It selects Champions with different interpersonal and social characteristics, who are more likely to be recognised by colleagues as leaders and whose influence extends further towards peripheral midwives in friendship networks. These improvements in organisational learning translate into more comprehensive and higher-quality clinical practice.