Health Economics

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Analysis of Health Care Utilization in Côte d'Ivoire
(AERC, 2020-04-27) Cisse, Alimatou
Health constitutes a sufficiently solid entrance to reduce poverty and promote economic growth. Yet, in most African countries and particularly in Côte d’Ivoire, the populations’ state of health has seen a real deterioration over the last decade. This study seeks to explain this decline by determining the explanatory factors of recourse to health care providers. To this end, the multinomial logit model is used. The theoretical basis for this analysis is the maximization of a utility function to produce health. The data to test the study’s hypotheses came from the survey of the National Institute of Statistics, entitled Social Dimension of Structural Adjustment, carried out in April 1993. The results show that the education level of the household head, the household’s income, the price of medication, and the time to reach the health care provider (as a proxy for the distance to a health care provider) determine the choice for a specific health care provider. The level of education and the income positively influence this choice, while the cost of medication and the time to provider (time to reach the health provider) negatively influence the choice of health care provider.
Analysis of the Technical Efficiency of Public Hospitals in Togo: A non-Parametric Approach
(AERC, 2018-01-02) Atake, Esso-Hanam
Most health facilities in Togo are poorly equipped. Consequently, the rate of post-natal consultation remains low and varies between 9.5% and 39.4%. Barely half of all deliveries (47.1%) take place in health facilities. In this study, we analysed technical efficiency scores of 139 Togolese public hospitals over the period 2008–2010, and then identified the determinants of this efficiency. Double bootstrap data envelopment analysis was used to draw consistent inferences. We first estimated bootstrapped efficiency scores. Then, bootstrapped truncated regression was used to identify the determinants of public hospitals efficiency. The results indicate that, on average, small-sized hospitals (periphery care units) investigated, had the highest efficiency scores. The University Teaching Hospitals and regional hospitals which have significant material, human and financial resources were associated with lower efficiency. The most significant and robust factors of technical efficiency are per capita income, competition, hospital’s balance, types of contract, and medical density. We found that income constraint and accessibility to health facilities are obstacles to efficiency. According to our results, we can infer that non-competitive public provision of health services is likely to be inefficient. Another important practical implication is that Togo must vigorously promote reform of the management system in public hospitals which regards corporate quality governance as the core. We hypothesize that if subsidies are allocated according to performance, they can positively affect efficiency. Policy makers should consider tying grant revenues to performance indicators.
Assessing User Satisfaction with the Quality of Healthcare Services in Cameroon
(AERC, 2021-05-04) Njong, Aloysius Mom; Tchouapi, Rosy Pascale Meyet
This study aims to evaluate user satisfaction with, and perceptions about the quality of, the healthcare services provided in health facilities in Cameroon. The analyses make use of the 2010 Quantitative Service Delivery Survey (QSDS), jointly carried out by the World Bank and the National Institute of Statistics in Cameroon. Confirmatory factor analysis is used to test the reliability and validity of the research instruments and hence facilitate the ranking of satisfaction indicators. We use ordered probit modelling to identify the covariates of user satisfaction. Results indicate that over 85% of users are satisfied with the overall quality of healthcare services in the country. There are some concerns about such dubiously high individual-level response rates, which are inconsistent with the poor reputation of the quality of healthcare services in CThis study aims to evaluate user satisfaction with, and perceptions about the quality of, the healthcare services provided in health facilities in Cameroon. The analyses make use of the 2010 Quantitative Service Delivery Survey (QSDS), jointly carried out by the World Bank and the National Institute of Statistics in Cameroon. Confirmatory factor analysis is used to test the reliability and validity of the research instruments and hence facilitate the ranking of satisfaction indicators. We use ordered probit modelling to identify the covariates of user satisfaction. Results indicate that over 85% of users are satisfied with the overall quality of healthcare services in the country. There are some concerns about such dubiously high individual-level response rates, which are inconsistent with the poor reputation of the quality of healthcare services in Cameroon. It also emerges from the study that age, educational status and waiting time are prominent covariates of satisfaction. The major policy recommendation is that an exit user satisfaction survey should be conducted to reduce the approval response biases observed in the 2010 QSDS data.ameroon. It also emerges from the study that age, educational status and waiting time are prominent covariates of satisfaction. The major policy recommendation is that an exit user satisfaction survey should be conducted to reduce the approval response biases observed in the 2010 QSDS data.
Birth Order and Demand for Immunization for Children under the Age of Five in Cameroon
(AERC, 2020-01-07) Rodrigue, Nda’chi Deffo; Vincent de Paul, Negou Kamga
Despite free basic vaccines administered by the Expanded Programme on Immunization (EPI), there is still a fairly high death rate of children aged 0-5 worldwide due to vaccine-preventable diseases. Sub-Saharan Africa is the most affected region due to low levels of vaccination. This study analyses the effect of birth order on the immunization status of children in Cameroon, considering the contribution of cultural, economic and community factors. To do this, it uses data from the Demographic and Health Surveys of 1991, 1998, 2004 and 2011 produced by the National Institute of Statistics with the support of UNFPA, UNICEF, the World Bank and USAID. The EPI module was administered to 3,350, 2,317, 8,125 and 25,524 children under five in 1991, 1998, 2004 and 2011, respectively. The multinomial probit model makes it possible to find that birth order has a negative and highly significant effect on the full and timely immunization of children under five and the impact increases with birth order. Moreover, the impact of birth order increases after adjusting for cultural factors. This increase indicates that, beyond the effect of birth order, cultural factors are at the root of prejudices leading to the abandonment of children. Considering children under two years of age, and vaccines taken during the first four months, the corresponding birth order effect points to the benefits of routine immunization and response campaigns in promoting immunization of children under five.
Breastfeeding and Child Health in Uganda
(African Economic Research consortium, 2020-12-10) Bbaale, Edward
The study set out to estimate the effect of breastfeeding on child mortality and stunting. We used nationally representative Uganda Demographic and Health Survey (UDHS) of 2011 merged with the community section of the Uganda National Household Survey (UNHS) of 2012/13 to include community variables, such as distance to the health facility, that are potential instrumental variables. We used various techniques: ordinary least squares (OLS), Instrumental Variables (IV) approach and control function during the analysis. We found that breastfeeding reduced child mortality but was weakly associated with child stunting. Just as previous literature documents, the OLS estimate of the coefficient on breastfeeding was biased downwards compared to the IV and control function estimates. Health knowledge was important in influencing child mortality. Government efforts towards sensitizing citizens about the importance of breastfeeding should be strengthened. Additionally, government needs to prioritize dissemination of health knowledge to women of reproductive age who are no longer in school. Furthermore, school curricula should be improved to include communication of health knowledge to students during early education to mitigate poor child health outcomes for future generations.
Can Results-Based Financing Help Reduce Wealth-Based Disparities in Maternal and Child Health Outcomes in Zimbabwe?
(African Economic Research Consortium, 2023-09-19) Makate, Marshall; Mahonye, Nyasha
Results-based financing (RBF) programme evaluations in sub-Saharan Africa (SSA) have concentrated on quantifying the impact of such programmes on maternal and child health outcomes, worker satisfaction and quality of care. Very few studies have considered assessing the effectiveness of these programmes from a distributive perspective. This study uses nationally representative data from the Zimbabwe demographic and health survey complemented with geographic location data. As a first step, the empirical approach quantifies wealth-related inequalities in selected maternal and child health outcomes using concentration indices at the district level. A standard difference-in-difference model complemented by kernel-based propensity score matching was used to consistently estimate the impact of the RBF programme on the equality of maternal and child health outcomes across socioeconomic gradients in Zimbabwe by comparing the changes in concentration indices between 2010 and 2015 in ten districts with RBF and thirty districts without the RBF programme for 12 indicators of access to maternal health care and nine indicators of child health outcomes. The results show that the RBF programme was associated with greater and significant improvements in equity related to several outcomes. These outcomes included: prenatal care use (four or more prenatal care visits), family planning, quality of prenatal care (blood pressure checks, iron tablets, and tetanus toxoid vaccinations), child full immunizations, and treatment for fever occurring in the two weeks before the survey. The RBF programme did not appear to ameliorate wealth-related inequality regarding child low birth weight, neonatal mortality, stunting, diarrhoea prevalence, treatment for diarrhoea, and fever prevalence. A sensitivity check of the estimates indicates that our results are weakly robust to considering absolute inequality measures (slope index of inequality and the generalized Gini index). From a policy perspective, the results have important implications for public health policies geared towards improving access to maternal and child health care services in developing countries. Our analysis reveals that RBF programmes do not necessarily eliminate wealth-related inequality in maternal and child health outcomes in Zimbabwe but are certainly a valuable complement to equity-enhancing policies in the country.
A Comparative Analysis of the Determinants of Seeking Prenatal Health Care in Urban and Rural Areas of Togo
(AERC, 2013-07) Johnson, Ablamba; Issifou, Alima; Homevoh, Etsri
A country may have invested significantly in essential health facilities in order to supply goods and services related to reproductive health, but still see the demand for prenatal health care influenced by equally important economic and social factors. The aim of the present study was to identify the economic and social factors that would determine the probability of a pregnant woman choosing one type of prenatal health care over another and to specifically measure the effects of the variables of living standards on seeking this care. The study used a multinomial logit model to analyze data collected during the 2006 Multiple Indicators Cluster Survey (MICS-3) survey. From the main results, the following observations could be made: (i) pregnant women without formal education went for prenatal consultations less frequently than those with formal education; (ii) the higher the wealth index was for the household in which the pregnant woman lived, the more likely that she would seek prenatal care from trained medical staff; (iii) the pregnant woman’s level of formal education, her age, the size of the household she lived in, the household’s wealth index, the number of children below five years living in the household, the cost of prenatal consultations at public health facilities, and the quality of care these offered, were all found to have a statistically significant effect on the pregnant woman’s choice to seek prenatal care from a modern health facility or not.
Corruption and Users in Douala-Cameroon Public Hospitals: An Evaluation of Determinants
(African Economic Research consortium, 2018-01-30) Bayemi, Oscar
This paper examines the factors that determine an individual's exposure to corruption in public hospitals in Douala, Cameroon. A survey of 407 users who attended these hospitals revealed corruption to be prevalent in services that are offered in sections such as reception, hospitalization and the drugstore. Estimates obtained through odds ratios reveal that in general, the determinants of a user’s exposure to corruption vary from one hospital to another and even from one service to another. For example, in the hospitalization service of the General hospital, these determinants are: Income above 250,000 FCFA, gender (male), educational level below university, and age over 40 years. On the contrary, in the hospitalization service of the Bonassama hospital, it is an income below 250,000 FCFA, woman, educational level below university, and age below 40 years. However, the educational level below university appears as a common determinant of corruption in all services and almost all hospitals. This allowed us to propose a typology of hospitals based on the factors behind this phenomenon.
Demand For Improved Water Quality: An Analysis of Averting Actions by Cameroonian Households
(African Economic Research consortium, 2018-01-04) Armand, Totouom Fotue Luc; Tagne, Sostaine Romuald Foueka; Poufoun, Jonas Ngouhouo
This study aims to investigate the demand for improved water quality in Cameroon by analysing the determinants of household averting actions to cope with unsafe drinking water. The study is based on primary data collected in 2013 from a sample of 789 households in the cities of Douala and Yaoundé, Cameroon. The econometric approach used in the study is the same as that of McConnell and Rosado (2000). The main findings of the estimated model are: the decision to adjust water quality decreases when income decreases, when there are no children under five in the household, and when the quality of the water consumed is not a concern. Also, the probability of adopting a given avoidance measure decreases with its cost of adoption and increases with its level of efficiency (measured by people’s favourable opinion on the quality of water after adjustment). Implications for public policies are discussed in the paper.
Determinants of Child Malnutrition in Mauritania
(African Economic Research consortium, 2020-01-04) Ly, Yahya Abou
The empirical context of this research is in an environment where malnutrition is a real public health concern. The objective of this study was to identify the determinants of the nutritional state of children under the age of five years in Mauritania. Using data obtained from multiple indicators cluster surveys (MICS) in Mauritania in 2007 and 2015, we undertook fixed-effects clusters techniques to control for unobserved heterogeneity. The empirical results demonstrate that the age and sex of a child, level of education of the mother, the standards of living of the household, the area of residence, the availability and use of health care services and access to drinking water are all important factors for the good health of children in Mauritania. These findings suggests improvements in nutritional health, for example, by education of girls until completion of secondary school; an improvement in the conditions of households that are headed by women and an expansion in the coverage rate of multi-purpose health centres.
The determinants of health care demand in Uganda: The case study of Lira District, Northern Uganda
(AERC, 2006-05-27) Jonathan J.A.O. Odwee; Francis Nathan Okurut; Asaf Adebua
The study investigated the price and non-price factors that affect health care demand in rural Uganda using household data from Lira district in northern Uganda, which is the poorest region. The government had introduced the user-fee scheme as a strategy for supplementing government budgets to improve health care delivery systems. The results suggested that the demand for government heath care services was negatively and significantly influenced by the user-fees and drug unavailability. A simulation analysis suggested that an increase in medical charges (user-fees) leads to a fall in demand for government health facilities but increases the demand for both private health facilities and self-medication. Controlling for drugs availability, the demand for government health facilities falls when drugs are not available while demand for private health facilities rises. The policy implication is that government should be able to put resources from things like debt relief to stocking the drugs in public health facilities while the internally generated tax revenues could be utilized to provide free health services especially to the poor. In the long run, the policy option of a social health insurance scheme may be explored.
Determinants of Neonatal and Under-five Mortality in Kenya: Do Antenatal and Skilled Delivery Care Services Matter?
(AERC, 2017-09) Machio, Phyllis Mumia
Declines in neonatal and under-five mortality in Kenya were much slower than what was required to meet the Millennium Development Goal (MDG) on childhood mortality. Therefore, while Tanzania and Uganda met and surpassed their MDG targets, Kenya did not. Effort is now directed at ending all preventable deaths among neonates and under-fives, as envisaged in the Sustainable Development Goals (SDGs). Most childhood mortality can be prevented by ensuring that women have access to quality care during conception, pregnancy, intra-partum and in the post-natal period. This study investigated the effects of antenatal and skilled delivery care services on neonatal and under-five mortality in Kenya using pooled Kenya demographic and health survey data for 1998, 2003, 2008/2009 and 2014. Two-stage residual inclusion estimation procedure and the control function approach were used to test and control for potential endogeneity of antenatal and skilled delivery care and for potential unobserved heterogeneity. The study unveiled presence of both endogeneity and unobserved heterogeneity and found that failure to control these would have biased downwards the effects of antenatal and skilled delivery care services on childhood mortality. Findings indicated that adequate use of antenatal care services reduced risk of neonatal and under-five mortality by 2.4 and 4.2 percentage points respectively. Similarly, use of skilled delivery care services was associated with reduced risk of neonatal and under-five mortality by 0.3 and 1.8 percentage points respectively. Increasing coverage of women using adequate antenatal care services and skilled delivery care services can reduce the risk of neonatal and under-five mortality in Kenya. Policies that promote use of these services such as promoting women education and reducing average distances to health facilities should be promoted.
Distribution Impact of Public Spending in Cameroon: The Case of Health Care
(AERC, 2008-05-07) Bernadette Dia Kamgnia
The study assessed Cameroonians’ participation in public health care services in order to grasp the distributional effects of those services. Three specific objectives are specified: determine the extent to which public spending on health care may constitute a targeted means for poverty reduction; identify the determinants of participation in health care services in general and in public services in particular; and propose alternative health care policies compatible with the government’s concern for poverty alleviation. In a benefit incidence analysis, it is shown that the benefits acquired from using publicly funded health care services are globally progressive. Integrated health care centres are chosen because of their nearness. Households appreciate the quality of services provided at the peripheral health care centres. Private health care is chosen because of the quality of the service, and people go to traditional healers or resort to self-medication because of the low cost. The majority of the considered factors – cost, nearness, revenue, education, age, gender and illness – had the expected sign and significantly affect the choice of health care providers. But for educated individuals who are employed in the formal sector, nearness and cost are the key variables in the design of health care policies.
Effect of Health Sector Grants on Availability and Quality of Healthcare in Kenya
(African Economic Research Consortium, 2021-07-16) Kiplagat, Isabella J.; . Musyoka, Philip K
This study seeks to investigate the effect of health sector grants on availability and quality of primary healthcare in Kenya while focusing on the effect of Health Sector Services Fund (HSSF), an innovative financing mechanism in which funds are channeled directly from the national government to the lowest tiers of healthcare providers in the country: the dispensaries, health centres and first level hospitals. Specifically, we sought to establish the effect of HSSF on availability and quality of healthcare in the country as measured by essential drug availability and provider illness diagnostic accuracy, respectively. The study used data from the Health Service Delivery Indicators and Public Expenditure Tracking Survey (SDI-PETs) conducted in Kenya in 2012/13. The analysis was based on basic microeconomic theory - the principal-agent theory. We appropriately used Ordinary Least Squares and probit models in regressing availability and quality of healthcare measures on HSSF status and a variety of control variables while controlling for endogeneity of HSSF receipt. The regression results point to the importance of Health Sector Services Grants (HSSF) amount and receipt in improving availability of essential drugs and quality of care, respectively. Thus, direct and increased funding to lower level health facilities enhances availability of individual essential medicines at the facility level. Similarly, HSSF funding was important in influencing accuracy in illness diagnosis. Other factors such as facility type and access to power influenced availability of essential drugs while health worker age-group and health worker training as indicated by cadre type were important determinants of provider process quality of healthcare.
Effects of Maternal Immunization on Birth Weight in Rural Cameroon
(African Economic Research consortium, 2021-01-20) Tambi, Mbu Daniel
This study investigated the effects of tetanus immunization on birth weight in rural Cameroon. Specifically, the study sought to: examine the determinants of mother’s immunization in Cameroon; assess the impact of mother tetanus immunization on child health production; examine how birth weight production function can be estimated by area of residence and household income; and propose policy implications on the basis of the findings. To tackle these objectives, the study used the ordinary least square (OLS) model. Empirical results were based on pooled data from the 2004 and 2011 demographic and health surveys (DHS) collected by the government’s statistics office. The results showed that maternal immunization during pregnancy was associated positively with birth weight, overall in rural and urban areas, and among poor and non-poor households. Other variables that were significantly associated with birth weight in rural Cameroon were: mother’s education in years of schooling, mother’s age, father’s age, first twin birth, male child birth, nonpoor, interaction of mother’s and father’s education and urban household residence. These results have implications for addressing child health concerns in the ongoing process of growth, employment and poverty reduction in terms of improving access to antenatal care and family planning in rural Cameroon.
Explaining the Decline in Child Stunting in Malawi between 2010 and 2015
(African Economic Research Consortium, 2021-07-15) Kumchules, Grace
In 1992, the prevalence of stunting among under five children was 49%. In 2000, 2004 and 2010, the prevalence of stunting remained persistently high at at 48%, 48% and 47%, respectively. However, this dropped dramatically to 37% in 2016, and led to considerable interest in understanding the drivers behind this improvement. Using the UNICEF conceptual framework, data from the 2010 and 2016 Malawi DHSs and Blinder-Oaxaca decomposition technique, this study could explain only 5% of the 10.5% decline in child stunting. This is attributable to improvements in standards of living in 2016, when the level of wealth status in households was observed to have improved. Focusing efforts on wealth creation can potentially reduce child malnutrition in Malawi.
Financial Inclusion and Resilience to COVID-19 Economic Shocks in Nigeria
(African Economic Research Consortium, 2024-04-11) Bénédicte, Atchade Touwédé
Using data from Benin’s Demographic and Health Surveys (DHS, 2018), we examined the impact of the purchasing power of women on the quality of life of children under the age of five years. More specifically, the study examined the impact of the decision-making power of the woman on the nutritional status of children and also of nutritional status on children’s immunization status, using a Multinomial Logit model with the households as the theoretical models. The results of our study generally show that when the woman is involved in decision making within her household, the nutritional status of children and their immunization status are satisfactory. Variables such as the age of the woman, her level of education, the level of education of the head of the household, the employment status of the head of the household, the main decision maker on the health of the children, the interval between child births, the level of wealth of the household and the sex of the child significantly improve the immunization status of children under the age of five years. However, variables such as the distance from a hospital, giving birth to twins and the order of birth have a negative impact on the immunization status of children. In regard to the nutritional status of children, variables such as the age of the woman, her level of education, the management of the income of the woman, the wealth level of the household, the fact that the child is a girl and the fact that the parents collectively decide on the health of the children lower the probability of the child being malnourished. However, variables such as birth order to the children, the fact that the children are twins and age of the child increase the probability of a child being malnourished. Initiatives and approaches therefore should be undertaken in order to increase the empowerment of women. The results of this study will have a positive impact on the nutritional status of women. In the short term, these recommendations should have an impact on the scholarly results of children, in the medium term on the labour market, and in the long term on sustained economic growth.
Financial Inclusion and Resilience to COVID-19 Economic Shocks in Nigeria
(African Economic Research Consortium, 2024-04-11) Adeniran, Adedeji P.; Muthinja, Moses M.
We examine the role of financial inclusion, ownership of bank accounts, and previous use of formal financial saving facilities as a resilience factor in the effect of COVID-19 on households' welfare in Nigeria. Using a novel data set that tracks food security among families in Nigeria before and during COVID-19, we find a negative effect of COVID-19 on welfare. The impact is more severe among male-headed households, those living in the southern region of Nigeria, and lower educated households. We also test how financial inclusion mitigates this effect through a triple difference analysis in which the households that are financially included and in non-agricultural sector are considered the treatment group. Financial inclusion did not support resilience to shock among non-agricultural homes. Given the magnitude and multisectoral dimension of the COVID-19 shock, financial inclusion was not enough to mitigate the effect. This, therefore, points to a role for stronger government support in a large shock like COVID-19.
Health Aid and Child Mortality in Developing Countries: Accounting for Transmission Mechanisms
(African Economic Research consortium, 2018-08-30) Mallaye, Douzounet; . Yogo, Thierry U
Using a sample of 94 developing countries over the period 1990-2011, this paper examines both the direct and indirect effect of health aid on child mortality. We test for this relationship using a dynamic panel data model. The results reveal that health aid decreases infant mortality in developing countries. More specifically, a 1% increase in health aid per capita leads to a 0.047% decrease in child mortality over five years. This effect operates mainly through the improvement of primary education completion rate of female and governance. However, the magnitude of the effects is too small if developing countries would like to achieve Millenium Development Goals (MDGs through) additional health aid. The policy implications of the paper are further discussed.
Health Insurance and the Economic Impact of Negative Health Outcomes in Ghana
(African Economic Research Consortium, 2021-08-23) Novignon, Jacob; Arthur, Eric; Nonvignon, Justice
In many developing countries, financial risk protection for health is underdeveloped and negative health outcomes can be impoverishing. In this study, we sought to investigate the impact of negative health outcomes on household welfare and the role of public health insurance in mitigating this impact. We used Ghana’s public-funded National Health Insurance Scheme as a case study. Data was from the sixth round of the Ghana Living Standards survey (GLSS). To address the potentially non-random nature of the Ghana health insurance scheme, a two-stage least squares (2SLS) estimation technique was used. The results suggest that longer days of illness leads to less hours of labour supply and this result was statistically significant across all specifications. We found no evidence of heterogeneous impact of negative health outcomes through health insurance coverage on hours of labour supply. However, disaggregating the results into the urban and rural, and the gender samples, we find that for rural dwellers and males who experienced longer days of illness, labour supply was less when they had access to health insurance. The findings call for policy that focuses on reforming the NHIS to ensure effectiveness and achieving its primary objectives. One option is to ensure availability of prescription drugs and to enhance the procedure for accessing services at healthcare centres to encourage participation and continuous renewal of subscription by Ghanaians.

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