Essays on Health Financing for the Poor

Abstract

Health systems aim to improve population health. Despite global efforts, millions of children still die every year from vaccine preventable diseases and undernutrition attributed deaths. Moreover, about 293,000 maternal deaths occurred in 2013. The sources of these deaths include various inequalities such as vaccine coverage, nutritional status, and health services utilization. In order to make progress toward mortality reduction, we need to address the sources that are most likely to affect the poorest. One strategy is conditional cash transfers (CCTs), which provides cash payments in exchange for compliance with health-related conditionality. This dissertation explores evidence from two large randomized experiments in Indonesia, PKH (a large-scale household CCT) and Generasi (a large-scale incentivized community block grant). Chapter two investigates whether PKH improves vaccination coverage among poor children. After two years of implementation, the results show that PKH leads to significant increase in vaccination coverage for all vaccine types among children younger than 12 months old. The evidence also suggests that PKH is equity enhancing by reducing the differences in vaccination coverage between children living in more and less supply-ready areas and children of more and less educated mothers. Chapter three investigates the impact of PKH and Generasi on child food intake. The results show that both programs increase child food intake particularly for protein-rich items. They increase milk and fish intake up to 19% and 14% compared to the control group means, respectively. Improving child nutrition outcomes, PKH reduces wasting and severe wasting up to 41% and Generasi reduces the prevalence of severely underweight children up to 47%, compared to the control areas. Chapter four explores how PKH and Generasi help improve determinants of maternal mortality among poor women. Evidence shows different results between the two programs with Generasi produces more positive impact in many aspects of determinants. Both programs, however, are unlikely to have a large effect on maternal mortality due to factors that might significantly reduce the program’s effectiveness. For instance, while the programs improved utilization, they did so at community-based facilities, which are not appropriate for delivery services in the case of obstetric emergency.