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The effect of government contracting with faith-based health care providers in Malawi

Author

Listed:
  • Wiktoria Tafesse

    (Centre for Health Economics, University of York, York, UK)

  • Gerald Manthalu

    (Ministry of Health, Government of Malawi)

  • Martin Chalkley

    (Centre for Health Economics, University of York, York, UK)

Abstract

We study the impact of contracting-out of maternal health care by the government of Malawi to providers from the Christian Health Association of Malawi (CHAM) in the form of Service Level Agreements (SLAs). Under a SLA, a CHAM facility provides agreed maternal and newborn services free-of-charge to patients, and is reimbursed on a fixed price per service. We merge data on health facilities in Malawi with pregnancy histories from the 2010 Malawi Demographic and Health Survey, and exploit the staggered implementation of SLAs across facilities. Using difference-in-differences, we estimate the differential effects on pregnancy- related health care utilisation to mothers residing near and far from facilities with a SLA over time. Our findings show that SLAs reduced home births and increased skilled deliveries at CHAM hospitals. We observe greater provision of prenatal care services at CHAM health centres but no overall increase in the number of prenatal care visits. We find evidence of a reduction in certain components of prenatal care.

Suggested Citation

  • Wiktoria Tafesse & Gerald Manthalu & Martin Chalkley, 2019. "The effect of government contracting with faith-based health care providers in Malawi," Working Papers 167cherp, Centre for Health Economics, University of York.
    • Handle: RePEc:chy:respap:167cherp
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    File URL: https://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP167_faith-based_health_care_providers_Malawi.pdf
    File Function: First version, 2019
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    More about this item

    Keywords

    Healthcare; Least Developed Country; Contracting Out; Nonprofit.;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L24 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Contracting Out; Joint Ventures
    • L30 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - General
    • L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out

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