Health Economics
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- ItemCan 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, NyashaResults-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.
- ItemThe Influence of Women Empowerment on Child Nutrition in Rural Nigeria(AERC, 2022-03) M.B., Salawu,; K.K, Salman; Rufai, A.M; I., OgunniyiWomen empowerment is key to reducing weak dietary diversity and chronic child malnutrition. In Nigeria, child malnutrition is persistent, despite several interventions, which failed to factor in the need to empower women to eradicate the menace. In thisstudy, we examined the influence of women empowerment on child nutrition in rural Nigeria, using the five basic domains of empowerment, namely: production, resources, income, leadership and time. Data from General Household Survey Panel 2015-2016 were analysed using Poisson regression, Ordinary Least Square regression and Instrumental Variables techniques to correct for potential endogeneity. The results show that most (over 90%) of households consumed cereals, vegetables, oils and fat, spices, condiments and beverages. They also show that, on average, women had access to less than two empowerment indicators, implying low empowerment among them. Women empowerment significantly increased household dietary diversity and consequently reduced the probability of child stunting. These findings support the claim that women empowerment is a pathway out of the cycle of weak dietary diversity and consistent child malnutrition in rural Nigeria. It is, therefore, recommended that complementary and supportive policies on women empowerment, aimed at preventing and reducing severe child malnutrition in Nigeria, should be strengthened.
- ItemHealth Insurance and the Economic Impact of Negative Health Outcomes in Ghana(African Economic Research Consortium, 2021-08-23) Novignon, Jacob; Arthur, Eric; Nonvignon, JusticeIn 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.
- ItemEffect of Health Sector Grants on Availability and Quality of Healthcare in Kenya(African Economic Research Consortium, 2021-07-16) Kiplagat, Isabella J.; . Musyoka, Philip KThis 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.
- ItemExplaining the Decline in Child Stunting in Malawi between 2010 and 2015(African Economic Research Consortium, 2021-07-15) Kumchules, GraceIn 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.