Essays on health shocks and the demand for heal th care in Uganda
This dissertation consists of three empirical essays in health economics on the demand for health care and the consequences of ill health on households. The goal was to draw upon newly available data to shed light on the factors that facilitate access to care and the impact of ill health on households. Findings from the studies are relevant to policy makers and program planners as they seek innovative ways to improve population health outcomes. Essay 1 of the dissertation - If you build it would they come? Facility-level characteristics that determine formal health service use in rural Uganda - explored the health facility related factors that are associated with use of health services in rural areas in Uganda. This study used a rich pooled data set on individual health seeking behavior linked to data on health care providers. In addition to using multilevel modelling methods as used in other similar studies, this paper explored the effect of selection on the sample of individuals who report using health care services during an illness episode. The most interesting finding was related to the level of the health facility and not the structural characteristics of the facility as hypothesized in this study. Although positively significant, the effect size of the associations between the availability of basic amenities, equipment and drugs and the use of formal curative health service in rural areas in Uganda was very small. The findings suggest that programs targeted at improving demand of health services amongst rural residents should pay attention as well to the supply side of the health market, especially to the levels of health facilities available. Essay 2 - The Impact of Recent Parental Illness on Schooling in Uganda - explored the link between health and educational outcomes. It examined the impact of recent illness of a parent on the educational outcomes of young persons with age 15 through 24 years in the household. This paper used panel data to estimate individual level fixed effects models of the effect of a recent parental illness on a young person’s current school attendance. Findings show that parental illness did not have a significant statistical impact on the current schooling of young person’s between 15 and 24 years. Nonetheless, the hours worked per week by children on household activities increased the most when only their father was ill. Additionally, per capita monthly household consumption expenditure also decreased only when the father alone fell ill in the previous month. These findings suggest that in this context, recent parental illness does not directly affect the school attendance of young persons in the household. However, recent parental illness does impact the labor distribution and consumption expenditure in the household. Essay 3 - Contextual factors associated with institutional delivery in Uganda – examines the contextual factors that are associated with health facility delivery in Uganda based on a pooled dataset of a nationally representative sample of pregnant women. The study results found limited evidence in broad support of the role of community level factors despite the findings in previous qualitative studies that contextual findings matter for promoting facility based delivery. Even so, the statistically significant findings on household head’s education, community socioeconomic status and travel time to a health facility are useful to program managers for defining the attributes for targeting and developing relevant nation-wide community level health promotion campaigns and to policy makers to support policies that encourage education on traditional 3 practices that are detrimental to population health and to promote economic empowerment initiatives especially in rural areas.