Reducing the Cost of Remoteness: Community Health Workers, Fertility Choices and Child Health Investments
Department of Economics
Friday, November 9, 2018
Taylor-Hibbard Seminar Room (Rm103)
12:00 pm-1:15 pm
Lack of primary health care use can increase preventable maternal and child deaths in low-income countries. Community health workers can be an alternative supply to deficient formal healthcare provision among underserved poor populations, but the empirical evidence on their impact on health outcomes is inconclusive. We analyze the short-term effects of a large-scale community-based health intervention on fertility and children’s health in Madagascar. Besides disseminating information to generate demand for primary care, the program aimed to decrease the non-monetary costs for remote households by training volunteer community health workers in delivering modern family planning and managing childhood illness. We use a triple difference model that combines the roll-out of the program across time and regions with geocoded data on the households’ distance to the closest health facility. Our findings indicate that the program decreased the probability of conception among women living close to the health facility but did not have a differential effect among women living in remote areas. In contrast, we find an improvement in vaccination uptake in areas distant from the health facility. We find suggestive evidence that that high-fertility preferences could have offset the program’s fertility reduction in remote areas.