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Does Proximity to Health Facilities Improve Child Survival? New Evidence from a Longitudinal Study in Rural Tanzania

Kante, M., Helleringer, S., Sigilbert, M., Levira, F., Masanja, H., Nathan, R., Noronha, J., Chung, C., Exavery, A., Hingora, A. and Phillips, J. F. (2013) Does Proximity to Health Facilities Improve Child Survival? New Evidence from a Longitudinal Study in Rural Tanzania. In: oes Proximity to Health Facilities Improve Child Survival? New Evidence from a Longitudinal Study in Rural Tanzania.

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Abstract

Distance to health facilities is often cited as a major barrier limiting access to care in sub-Saharan and other developing countries. There are however limited data on the causal effects of distance to facilities on child survival. Existing estimates may be biased because 1) most existing data are on distance to health care facilities are cross-sectional, and 2) existing analyses do not account for the endogeneity of residential choices and health services location. This paper uses unique longitudinal data collected in a rural district of Tanzania to test whether enhanced proximity to health services arising from investment in dispensaries contributed to the rapid decline in underfive mortality recently observed in Tanzania. Data on births, deaths, household socioeconomic characteristics and migrations have been recorded every 120 days since 1999 (n≈85,000). Geographic data on the precise location of households and health facilities have also been collected over time. We use multivariate analysis 1) to measure the causal effects of distance to health facilities on child survival and 2) to test for possible interactions between distance to health facilities and socioeconomic characteristics of households (e.g., educational attainment, wealth). Initial results indicate that, from 2000 to 2010, child mortality declined close to 40% (from 110 to 70 per 1000). The distance to the closest health facility remained a strong determinant of child survival, even after adjusting for endogeneity biases. The development of community-based primary health care in rural communities by posting community health assistants, and conducting regular household visits, can improve health outcomes. It can also increase equity by offsetting the detrimental effects of low maternal education, householdpoverty and distance to health facilities.

Item Type: Conference or Workshop Item (Paper)
Keywords: Health facility, Child survival, sub-Saharan Africa, Tanzania, Demography, health care, birth, death, maternal education
Subjects: Health Systems > Surveillance, monitoring & evaluation
Maternal & Neonatal Health > Neonatal Health
Divisions: Ifakara Health Institute > Health Systems
Depositing User: Mr Joseph Madata
Date Deposited: 13 Jan 2016 08:23
Last Modified: 13 Jan 2016 08:23
URI: http://ihi.eprints.org/id/eprint/3525

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