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Economic Analysis of under-five Morbidity, Mortality and Health-seeking Behaviour – Evidence from Ghana (eBook, PDF)

Beschreibung

Maternal and child health issues remain central to national and global health policies. Among the eight Millennium Development Goals (MDGs) that were adopted by the 189 members of the United Nations (UN) in 2000, at least four are directly related to maternal and child health care. Consequently, this dissertation seeks to provide some insight by investigating three main areas of maternal and child health concerns. Firstly, we examine the factors driving the high under-five mortality rate with emphasis on supply side variables with public goods characteristics such as road infrastructure and nurse-per-population. It is envisaged that access to and utilization of allopathic care will reduce under-five mortality. Secondly, the study investigates the socio-economic and supply side factors influencing the demand for particular health providers’ services. Thus conditional on childhood sickness, we investigate the type of health facility that parents or caregivers demand for children aged under-five years and the extent to which consumers are satisfied with health providers. In recent times, health insurance is considered an effective mechanism for inducing the demand for appropriate health care. If women in the reproductive age own health insurance, their own health and that of their children will improve and inherently, a reduction in under-five mortality. Thirdly, the study also explores the factors influencing a woman’s decision to participate in health insurance and also investigates the socio-economic determinants of household’s collective insurance decision. To achieve the above objectives, 531 women (aged 15-49) who had at least one live birth between 2002 and 2007 were interviewed using stratified random sampling technique in three Districts in Ghana between October 2007 and February 2008. Methodologically, a mix of discrete choice and duration models are employed to address the objectives. Using the Weibull parametric model; the study reveals that health inputs such as the utilization of antenatal care, childhood vaccination and Insecticide (mosquito) Treated Bednets are significant in curbing under-five mortality in Ghana. Supply side inputs particularly nurse-per-population and road infrastructure were statistically significant and inversely related to under-five mortality. Conversely, multiple births and higher order births are positively associated with under-five mortality. Household income had a puzzling positive relationship with under-five mortality, albeit weakly significant. In the case of the demand for a given provider’s services conditional on childhood sickness, multinomial choice model is utilized. In addition, the ordered logit model is used to investigate the impact of the choice of a given providers’ services on consumer satisfaction of health care. The study reveals that household income is positively and significantly related to the demand for private medical care. In fact, the effect of income on private medical care is quadratic in nature. In the case of mothers who took their children to pharmacy shops, traditional healers and resorted to self treatment, the impact of income was less pronounced. Waiting time at the health facility which denotes opportunity cost was consistently and inversely related to the demand for private medical care, faith healing and self treatment. More importantly, supply side variables such as hospital-bed-per population and road infrastructure are significant predictors of the demand for private health care. After controlling for other covariates, subscribers of private health care are approximately 12 percentage points more satisfied than those who subscribe to public health care. This suggests that the quality of care in private health facilities outweighs that of public health delivery. Provider characteristics particularly distance and waiting time were found to be inversely and significantly related to consumer satisfaction. In all, there are lower levels of satisfaction associated with the use of alternative health care providers. An important policy recommendation of this finding is that there is the tendency for allopathic care to increase at the expense of self treatment and traditional or faith healing as the quality of both private and public health care improves over time. Using binary logit model, the study found that supply side factors particularly health inputs via availability of nurses and proximity (distance) are significant determinants of a woman’s propensity to participate in health insurance. In terms of the household collective insurance decision, the fractional logit model was employed. At the household level, the study finds that nurse-per-population and distance to the nearest health facility were consistently and inversely related to the number of household members insured. The study concludes unequivocally that increasing physical infrastructure such as tarred roads and health inputs such as nurses and hospital beds will increase the demand for modern health care and reduce the risk of under-five mortality. Given that the level of existing physical infrastructure (tarred roads) is inadequate, health care policies should urgently focus on increasing the level of public spending on physical and material infrastructure in order to achieve significant reductions in under-five mortality.

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Produktdetails

• Verlag: Cuvillier Verlag
• Seitenzahl: 202
• Erscheinungstermin: 1. Februar 2010
• Englisch
• ISBN-13: 9783736932418
• Artikelnr.: 49149530