IDEAS home Printed from https://ideas.repec.org/a/eee/jhecon/v73y2020ics0167629619309452.html
   My bibliography  Save this article

Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices

Author

Listed:
  • Herrera-Almanza, Catalina
  • Rosales-Rueda, Maria F.

Abstract

Distance to health centers can represent a significant healthcare cost for poor households. Community-based health interventions and community health workers can be an alternative to deficient formal health care provision among remote populations. We analyze the effects on fertility outcomes of a large-scale community-based health worker program that aims to reach remote areas distant from health facilities in Madagascar. We use a triple difference model that exploits time and geographic variation in the program rollout and the geocoded household distance to the closest health facility. Our findings indicate that the program decreased the probability of conception among women in treated areas but did not have a differential effect among women living in remote areas. A potential mechanism underlying this fertility reduction is that the program increased women’s modern contraceptive use.

Suggested Citation

  • Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2020. "Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices," Journal of Health Economics, Elsevier, vol. 73(C).
    • Handle: RePEc:eee:jhecon:v:73:y:2020:i:c:s0167629619309452
    DOI: 10.1016/j.jhealeco.2020.102365
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0167629619309452
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.jhealeco.2020.102365?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Shareen Joshi & T. Schultz, 2013. "Family Planning and Women’s and Children’s Health: Long-Term Consequences of an Outreach Program in Matlab, Bangladesh," Demography, Springer;Population Association of America (PAA), vol. 50(1), pages 149-180, February.
    2. Abhijit Banerjee & Rukmini Banerji & James Berry & Esther Duflo & Harini Kannan & Shobhini Mukerji & Marc Shotland & Michael Walton, 2017. "From Proof of Concept to Scalable Policies: Challenges and Solutions, with an Application," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 73-102, Fall.
    3. Grant Miller & Kimberly Singer Babiarz, 2016. "Family Planning Program Effects: Evidence from Microdata," Population and Development Review, The Population Council, Inc., vol. 42(1), pages 7-26, March.
    4. Cesur, Resul & Güneş, Pınar Mine & Tekin, Erdal & Ulker, Aydogan, 2017. "The value of socialized medicine: The impact of universal primary healthcare provision on mortality rates in Turkey," Journal of Public Economics, Elsevier, vol. 150(C), pages 75-93.
    5. Victoria Baranov & Hans-Peter Kohler, 2018. "The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi," American Economic Journal: Applied Economics, American Economic Association, vol. 10(1), pages 266-306, January.
    6. Alberto Abadie & Susan Athey & Guido W Imbens & Jeffrey M Wooldridge, 2023. "When Should You Adjust Standard Errors for Clustering?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 138(1), pages 1-35.
    7. Adrienne M. Lucas & Nicholas L. Wilson, 2018. "Can At-Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?," American Journal of Health Economics, University of Chicago Press, vol. 4(3), pages 358-382, Summer.
    8. Jalan, Jyotsna & Somanathan, E., 2008. "The importance of being informed: Experimental evidence on demand for environmental quality," Journal of Development Economics, Elsevier, vol. 87(1), pages 14-28, August.
    9. Eliana La Ferrara & Alberto Chong & Suzanne Duryea, 2012. "Soap Operas and Fertility: Evidence from Brazil," American Economic Journal: Applied Economics, American Economic Association, vol. 4(4), pages 1-31, October.
    10. Kremer, Michael & Glennerster, Rachel, 2011. "Improving Health in Developing Countries," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 201-315, Elsevier.
    11. Michael Kremer & Jessica Leino & Edward Miguel & Alix Peterson Zwane, 2011. "Spring Cleaning: Rural Water Impacts, Valuation, and Property Rights Institutions," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 126(1), pages 145-205.
    12. Martina Björkman Nyqvist & Andrea Guariso & Jakob Svensson & David Yanagizawa-Drott, 2019. "Reducing Child Mortality in the Last Mile: Experimental Evidence on Community Health Promoters in Uganda," American Economic Journal: Applied Economics, American Economic Association, vol. 11(3), pages 155-192, July.
    13. Ashraf, Nava & Bandiera, Oriana & Jack, B. Kelsey, 2014. "No margin, no mission? A field experiment on incentives for public service delivery," Journal of Public Economics, Elsevier, vol. 120(C), pages 1-17.
    14. Achyuta Adhvaryu & Anant Nyshadham, 2015. "Return to Treatment in the Formal Health Care Sector: Evidence from Tanzania," American Economic Journal: Economic Policy, American Economic Association, vol. 7(3), pages 29-57, August.
    15. Melissa S. Kearney & Phillip B. Levine, 2015. "Media Influences on Social Outcomes: The Impact of MTV's 16 and Pregnant on Teen Childbearing," American Economic Review, American Economic Association, vol. 105(12), pages 3597-3632, December.
    16. Rebecca L. Thornton, 2008. "The Demand for, and Impact of, Learning HIV Status," American Economic Review, American Economic Association, vol. 98(5), pages 1829-1863, December.
    17. Jessica Cohen & Pascaline Dupas & Simone Schaner, 2015. "Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial," American Economic Review, American Economic Association, vol. 105(2), pages 609-645, February.
    18. Cameron, Lisa & Olivia, Susan & Shah, Manisha, 2019. "Scaling up sanitation: Evidence from an RCT in Indonesia," Journal of Development Economics, Elsevier, vol. 138(C), pages 1-16.
    19. Mary Arends-Kuenning, 2001. "How do family planning workers’ visits affect women’s contraceptive behavior in bangladesh?," Demography, Springer;Population Association of America (PAA), vol. 38(4), pages 481-496, November.
    20. Kelly M. Jones, 2015. "Contraceptive Supply and Fertility Outcomes: Evidence from Ghana," Economic Development and Cultural Change, University of Chicago Press, vol. 64(1), pages 31-69.
    21. Grant Miller and Kimberly Singer Babiarz, 2016. "Family Planning Program Effects: A Review of Evidence from Microdata - Working Paper 422," Working Papers 422, Center for Global Development.
    22. Gil Shapira & Ina Kalisa & Jeanine Condo & James Humuza & Cathy Mugeni & Denis Nkunda & Jeanette Walldorf, 2018. "Going beyond incentivizing formal health providers: Evidence from the Rwanda Community Performance‐Based Financing program," Health Economics, John Wiley & Sons, Ltd., vol. 27(12), pages 2087-2106, December.
    23. Karthik Muralidharan & Paul Niehaus, 2017. "Experimentation at Scale," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 103-124, Fall.
    24. Stopnitzky, Yaniv, 2017. "No toilet no bride? Intrahousehold bargaining in male-skewed marriage markets in India," Journal of Development Economics, Elsevier, vol. 127(C), pages 269-282.
    25. Hilary Hoynes & Diane Whitmore Schanzenbach & Douglas Almond, 2016. "Long-Run Impacts of Childhood Access to the Safety Net," American Economic Review, American Economic Association, vol. 106(4), pages 903-934, April.
    26. Rossin, Maya, 2011. "The effects of maternity leave on children's birth and infant health outcomes in the United States," Journal of Health Economics, Elsevier, vol. 30(2), pages 221-239, March.
    27. Pascaline Dupas, 2011. "Health Behavior in Developing Countries," Annual Review of Economics, Annual Reviews, vol. 3(1), pages 425-449, September.
    28. Dor, Avi & Gertler, Paul & van der Gaag, Jacques, 1987. "Non-price rationing and the choice of medical care providers in rural Cote d'Ivoire," Journal of Health Economics, Elsevier, vol. 6(4), pages 291-304, December.
    29. Catalina Herrera Almanza & David E. Sahn, 2018. "Early Childbearing, School Attainment, and Cognitive Skills: Evidence From Madagascar," Demography, Springer;Population Association of America (PAA), vol. 55(2), pages 643-668, April.
    30. Tania Barham, 2012. "Enhancing Cognitive Functioning: Medium-Term Effects of a Health and Family Planning Program in Matlab," American Economic Journal: Applied Economics, American Economic Association, vol. 4(1), pages 245-273, January.
    31. Madajewicz, Malgosia & Pfaff, Alexander & van Geen, Alexander & Graziano, Joseph & Hussein, Iftikhar & Momotaj, Hasina & Sylvi, Roksana & Ahsan, Habibul, 2007. "Can information alone change behavior? Response to arsenic contamination of groundwater in Bangladesh," Journal of Development Economics, Elsevier, vol. 84(2), pages 731-754, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 5th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-05 11:00:05

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2023. "Community-based health programs and child vaccinations: Evidence from Madagascar," World Development, Elsevier, vol. 170(C).
    2. Bancalari, Antonella & Berlinski, Samuel & Buitrago, Giancarlo & García, María Fernanda & de la Mata, Dolores & Vera-Hernandez, Marcos, 2023. "Health inequalities in Latin American and the Caribbean: child, adolescent, reproductive, metabolic syndrome and mental health," LSE Research Online Documents on Economics 120559, London School of Economics and Political Science, LSE Library.
    3. Bancalari, Antonella & Bernal, Pedro & Celhay, Pablo & Martinez, Sebastian & Sánchez, Maria Deni, 2023. "An Ounce of Prevention for a Pound of Cure: Efficiency of Community-Based Healthcare," IZA Discussion Papers 16350, Institute of Labor Economics (IZA).
    4. Bancalari, Antonella & Bernal, Pedro & Celhay, Pablo & Martinez, Sebastian & Sánchez, María Deni, 2024. "An Ounce of Prevention for a Pound of Cure: Basic Health Care and Efficiency in Health Systems," IDB Publications (Working Papers) 13433, Inter-American Development Bank.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Bancalari, Antonella & Bernal, Pedro & Celhay, Pablo & Martinez, Sebastian & Sánchez, Maria Deni, 2023. "An Ounce of Prevention for a Pound of Cure: Efficiency of Community-Based Healthcare," IZA Discussion Papers 16350, Institute of Labor Economics (IZA).
    2. Mesnard, Alice & Vera-Hernández, Marcos & Fitzsimons, Emla & Malde, Bansi, 2012. "Household Responses to Information on Child Nutrition: Experimental Evidence from Malawi," CEPR Discussion Papers 8915, C.E.P.R. Discussion Papers.
    3. Ahmad, Husnain F. & Gibson, Matthew & Nadeem, Fatiq & Nasim, Sanval & Rezaee, Arman, 2022. "Forecasts: Consumption, Production, and Behavioral Responses," IZA Discussion Papers 15831, Institute of Labor Economics (IZA).
    4. Finlay, Jocelyn E., 2021. "Women’s reproductive health and economic activity: A narrative review," World Development, Elsevier, vol. 139(C).
    5. Krämer, Marion & Kumar, Santosh & Vollmer, Sebastian, 2021. "Anemia, diet, and cognitive development: Impact of health information on diet quality and child nutrition in rural India," Journal of Economic Behavior & Organization, Elsevier, vol. 190(C), pages 495-523.
    6. Fitzsimons, Emla & Malde, Bansi & Mesnard, Alice & Vera-Hernández, Marcos, 2016. "Nutrition, information and household behavior: Experimental evidence from Malawi," Journal of Development Economics, Elsevier, vol. 122(C), pages 113-126.
    7. Renard, Yohan, 2022. "From fees to free: User fee removal, maternal health care utilization and child health in Zambia," World Development, Elsevier, vol. 156(C).
    8. Bancalari, Antonella & Bernal, Pedro & Celhay, Pablo & Martinez, Sebastian & Sánchez, María Deni, 2024. "An Ounce of Prevention for a Pound of Cure: Basic Health Care and Efficiency in Health Systems," IDB Publications (Working Papers) 13433, Inter-American Development Bank.
    9. Dillon, Andrew & Friedman, Jed & Serneels, Pieter, 2014. "Health Information, Treatment, and Worker Productivity: Experimental Evidence from Malaria Testing and Treatment among Nigerian Sugarcane Cutters," IZA Discussion Papers 8074, Institute of Labor Economics (IZA).
    10. Afridi, Farzana & Debnath, Sisir & Somanathan, E., 2021. "A breath of fresh air: Raising awareness for clean fuel adoption," Journal of Development Economics, Elsevier, vol. 151(C).
    11. Fitzpatrick, Anne & Beg, Sabrin & Derksen, Laura & Karing, Anne & Kerwin, Jason & Lucas, Adrienne M. & Ordaz Reynoso, Natalia & Squires, Munir, 2021. "Health knowledge and non-pharmaceutical interventions during the Covid-19 pandemic in Africa," Journal of Economic Behavior & Organization, Elsevier, vol. 190(C), pages 33-53.
    12. Cassidy, Rachel & Groot Bruinderink, Marije & Janssens, Wendy & Morsink, Karlijn, 2021. "The power to protect: Household bargaining and female condom use," Journal of Development Economics, Elsevier, vol. 153(C).
    13. Abramovsky, Laura & Augsburg, Britta & Lührmann, Melanie & Oteiza, Francisco & Rud, Juan Pablo, 2023. "Community matters: Heterogeneous impacts of a sanitation intervention," World Development, Elsevier, vol. 165(C).
    14. Michael Greenstone & B. Kelsey Jack, 2013. "Envirodevonomics: A Research Agenda for a Young Field," NBER Working Papers 19426, National Bureau of Economic Research, Inc.
    15. Derksen, Laura & Muula, Adamson & van Oosterhout, Joep, 2022. "Love in the time of HIV: How beliefs about externalities impact health behavior," Journal of Development Economics, Elsevier, vol. 159(C).
    16. Cohen, Jessica & Saran, Indrani, 2018. "The impact of packaging and messaging on adherence to malaria treatment: Evidence from a randomized controlled trial in Uganda," Journal of Development Economics, Elsevier, vol. 134(C), pages 68-95.
    17. Pascaline Dupas & Edward Miguel, 2016. "Impacts and Determinants of Health Levels in Low-Income Countries," NBER Working Papers 22235, National Bureau of Economic Research, Inc.
    18. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2023. "Community-based health programs and child vaccinations: Evidence from Madagascar," World Development, Elsevier, vol. 170(C).
    19. Hoffmann, Vivian E. & Moser, Christine M. & Herrman, Timothy, 2017. "Demand for aflatoxin-safe maize in Kenya: Dynamic response to price and advertising," 2017 Annual Meeting, July 30-August 1, Chicago, Illinois 259133, Agricultural and Applied Economics Association.
    20. Brown, Joe & Hamoudi, Amar & Jeuland, Marc & Turrini, Gina, 2017. "Seeing, believing, and behaving: Heterogeneous effects of an information intervention on household water treatment," Journal of Environmental Economics and Management, Elsevier, vol. 86(C), pages 141-159.

    More about this item

    Keywords

    Community Health Workers; Cost of Remoteness; Fertility; Africa;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I - Health, Education, and Welfare
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:jhecon:v:73:y:2020:i:c:s0167629619309452. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/505560 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.