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

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• Publisher: Cuvillier Verlag
• Year: 2010
• eBook ISBN:
  9783736932418
• Print ISBN:
  9783869552415
• Edition: 1

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 189members of the United Nations (UN) in 2000, at least four are directly related to maternaland child health care. Consequently, this dissertation seeks to provide some insight byinvestigating three main areas of maternal and child health concerns. Firstly, we examine thefactors driving the high under-five mortality rate with emphasis on supply side variableswith public goods characteristics such as road infrastructure and nurse-per-population. It isenvisaged 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 thedemand for particular health providers' services. Thus conditional on childhood sickness, weinvestigate the type of health facility that parents or caregivers demand for children agedunder-five years and the extent to which consumers are satisfied with health providers. Inrecent times, health insurance is considered an effective mechanism for inducing the demandfor appropriate health care. If women in the reproductive age own health insurance, theirown health and that of their children will improve and inherently, a reduction in under-fivemortality. Thirdly, the study also explores the factors influencing a woman's decision toparticipate in health insurance and also investigates the socio-economic determinants ofhousehold's collective insurance decision.To achieve the above objectives, 531 women (aged 15-49) who had at least one livebirth between 2002 and 2007 were interviewed using stratified random sampling techniquein three Districts in Ghana between October 2007 and February 2008. Methodologically, amix 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 theutilization of antenatal care, childhood vaccination and Insecticide (mosquito) TreatedBednets are significant in curbing under-five mortality in Ghana. Supply side inputsparticularly nurse-per-population and road infrastructure were statistically significant andinversely related to under-five mortality. Conversely, multiple births and higher order birthsare positively associated with under-five mortality. Household income had a puzzlingpositive relationship with under-five mortality, albeit weakly significant.In the case of the demand for a given provider's services conditional on childhoodsickness, multinomial choice model is utilized. In addition, the ordered logit model is used toinvestigate the impact of the choice of a given providers' services on consumer satisfactionof health care. The study reveals that household income is positively and significantlyrelated to the demand for private medical care. In fact, the effect of income on privatemedical care is quadratic in nature. In the case of mothers who took their children topharmacy shops, traditional healers and resorted to self treatment, the impact of income wasless pronounced. Waiting time at the health facility which denotes opportunity cost wasconsistently and inversely related to the demand for private medical care, faith healing andself treatment. More importantly, supply side variables such as hospital-bed-per populationand road infrastructure are significant predictors of the demand for private health care.After controlling for other covariates, subscribers of private health care areapproximately 12 percentage points more satisfied than those who subscribe to public healthcare. This suggests that the quality of care in private health facilities outweighs that of publichealth delivery. Provider characteristics particularly distance and waiting time were found tobe inversely and significantly related to consumer satisfaction. In all, there are lower levelsof satisfaction associated with the use of alternative health care providers. An importantpolicy recommendation of this finding is that there is the tendency for allopathic care toincrease at the expense of self treatment and traditional or faith healing as the quality of bothprivate and public health care improves over time.Using binary logit model, the study found that supply side factors particularly healthinputs via availability of nurses and proximity (distance) are significant determinants of awoman's propensity to participate in health insurance. In terms of the household collectiveinsurance decision, the fractional logit model was employed. At the household level, thestudy finds that nurse-per-population and distance to the nearest health facility wereconsistently and inversely related to the number of household members insured.The study concludes unequivocally that increasing physical infrastructure such astarred roads and health inputs such as nurses and hospital beds will increase the demand formodern health care and reduce the risk of under-five mortality. Given that the level ofexisting physical infrastructure (tarred roads) is inadequate, health care policies shouldurgently focus on increasing the level of public spending on physical and materialinfrastructure in order to achieve significant reductions in under-five mortality.