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  • May 22, 2023

Improving local health care in developing countries

How important is doctor-provided care?

Source: Prostock-studio

In 2016, Nigeria had one doctor for every 2,500 individuals. That’s better than the one per 5,000 on average in Sub-Saharan Africa but far worse than the ratio in developed countries like the United States, where there is roughly one doctor for every 370 individuals.

It has been shown that policies expanding access to primary health care in developing countries can have disappointing results, and many have suggested that an increase in quality, not just quantity, is a key factor in success.

In a paper in the American Economic Review, author Edward N. Okeke provides evidence on the role of quality in explaining health-care outcomes in the developing world. 

His findings come from an experiment in Nigeria where communities that previously received their health care from midlevel health-care providers (MLPs), such as a nurses and midwives, were randomly selected to receive either a doctor or an additional MLP for one year.  A third group received no additional health-care workers.

Figure 3 from Okeke’s paper shows the impact of this experiment on the probability of infant death within a week of birth.



Figure 3 from Edward Okeke (2023)


The gray squares represent control communities, i.e. sites that didn’t receive a new health-care worker; the blue diamonds represent communities that received an MLP; and the red circles represent communities that received a recently trained doctor. 

The chart illustrates that adding a doctor significantly reduced seven-day infant deaths compared to the control. But it also shows that adding an MLP had no impact. Overall, Okeke finds that assigning a doctor reduced mortality between 0.5 and 0.8 percentage points—an effect large enough to eliminate the newborn mortality gap between rural and urban areas in Nigeria.

The results suggest that policymakers who want to address Africa’s health-care problems should focus on increasing access to good-quality medical care.

When a Doctor Falls from the Sky: The Impact of Easing Doctor Supply Constraints on Mortality appears in the March 2023 issue of the American Economic Review.