Program Effects on Childrens’ Health
Paper Session
Sunday, Jan. 5, 2025 8:00 AM - 10:00 AM (PST)
- Chair: Shiko Maruyama, Jinan University
Impact of Supply-Side Conditional Cash Transfers on Women’s and Children’s Healthcare Outcomes: Evidence from Experimental and Observational data
Abstract
Improved access to healthcare services is associated with a reduction in poor health outcomes. This study leverages a large-scale randomized field experiment and observational data to provide robust evidence on the short- and long-term effects of a supply-side conditional cash transfers (SS-CCTs) scheme on women's and children's healthcare outcomes in Afghanistan. Under the SS-CCTs scheme, healthcare workers receive transfers conditioned on increasing the number of provided healthcare services. Two years after the SS-CCTs pilot, women and children assigned to healthcare workers in the treatment group are more likely to utilize healthcare services compared to the control group. The effects of SS-CCTs on healthcare outcomes vary across household wealth quantiles and the education status of women, with educated women and wealthier households benefiting the most. In contrast to the positive short-term effects, SS-CCTs have a negative impact on women's and children's healthcare outcomes in the long term. These long-term negative effects are primarily driven by lower human resource levels and decreased healthcare quality indices at treated health facilities post-SS-CCTs. Despite these challenges, SS-CCTs promote timely access to antenatal care, institutional delivery, and essential immunizations, contributing to the achievement of global health targets such as the Sustainable Development Goals (SDGs).Workforce Quality in Early Years Interventions: Evidence from a Large-Scale Home Visiting Program
Abstract
Targeted early years programmes can have significant benefits for children’s development; however, some early interventions have failed to live up to their promise when delivered at scale. Why this happens remains a puzzle in the literature. In this paper, we consider the role of a crucial input in scaled- up programmes: workforce effectiveness. We evaluate the degree of heterogeneity in workforce effectiveness in the context of the highly trained workforce employed by a successful, at-scale home visiting programme in England. Using the quasi-random assignment of workers to families for identification and unusually rich linked mother-child-worker data on a million of home visits, we estimate each worker’s effectiveness at retaining mothers, and at promoting their children’s physical, cognitive and socio-emotional development. We find evidence of substantial heterogeneity in workforce effectiveness: a one-standard deviation increase in quality leads to a 0.24SD increase in cognitive performance at age 2, and a 0.29SD increase in socio-emotional development. More effective family nurses cannot be predicted on the basis of observable characteristics (structural quality indicators), rather from what they do during the visits, and their capacity to establish close and trustful interactions with the mothers (process quality indicators). We also provide suggestive evidence that more effective family nurses at improving child development improve maternal healthy behaviors and maternal mental health. Our findings have important implications for hiring, training and retaining effective workers in home visiting programmes at scale.The Repeal of Mexico’s Seguro Popular and its Potential Impact on Infant Mortality
Abstract
Concerns over excessive out-of-pocket health expenditures in Mexico led to Seguro Popular (SP), a voluntary public health insurance program. Within SP, the Mexican government designed initiatives to address infant mortality. President López Obrador repealed SP and replaced it with INSABI, creating disorder as (1) inexperienced central government officials replaced municipality officials; (2) there was little to no planning for how to replace SP, particularly on the eve of the COVID-19 pandemic; and (3) there was inadequate investment in INSABI. Using Mexico’s National Institute of Statistics and Geography (INEGI) full registry from 2012-2022, we identify births and deaths of persons under the age of one. We examine infant mortality rates per 1000 births in municipalities that experienced a significant loss in public coverage due to the transition from SP to INSABI, compared to municipalities with low average SP enrollment prior to its repeal, thus experiencing a smaller decline in public coverage. The loss of public insurance is the difference of (1) the average pre-repeal public insurance enrollment rate at birth during 2012-2019 and (2) the average post-repeal public insurance enrollment rate at birth during 2020-2022. We employ a difference-in-differences (DiD) model comparing outcomes in municipalities with high-public-insurance loss to those with low-public-insurance loss. The average number of uninsured or SP-enrolled infant deaths was approximately 18,000 per year among the ~2,450 Mexican municipalities. SP reduced the proportion of uninsured infant deaths from 60% to ~20%. Following the repeal of SP, the proportion of uninsured infant deaths returned to ~50%. DiD reveals that there were 12.71 additional infant deaths per 1,000 births in municipalities with high-public-insurance loss following the repeal of SP relative to municipalities with a low-public-insurance-loss (p=0.035). This corresponds to a 50.09 percent-change increase in mortality from a base rate of 25.37.Discussant(s)
Will Dow
,
Berkeley University
Joseph Doyle
,
Massachusetts Institute of Technology
Jeffrey Hicks
,
University of Toronto
Zoe McLaren
,
University of Maryland-Baltimore County
JEL Classifications
- I1 - Health