Healthy Workforce, Healthy Baby? Quantitative and Political Analyses of Health Workers in Mexico

Abstract

Each year, almost five million babies die within their first year of life, from largely preventable causes. Insufficient availability of health workers has been identified as one of the most common barriers to delivering effective newborn healthcare. This dissertation focuses on the allocation and effectiveness of health workers at improving child health in Mexico. The first two chapters of this dissertation use municipality-level fixed effects analyses to assess the relationship between health workers and child health, specifically infant mortality rate (IMR) and two key risk factors for infant mortality: preterm birth prevalence and low birth weight prevalence. In the first chapter, we find that increasing physician density and nurse density both significantly decrease IMR but the effect of adding one physician (4.6 fewer deaths per 1,000 live births, p<0.001) is substantially larger than the effect of adding one nurse (2.5 fewer deaths per 1,000 live births, p<0.001) to a municipality with baseline physician and nurse densities of zero. In the second chapter, we did not find any significant effect of any health worker density on preterm birth or low birth weight prevalence. The findings from chapters one and two suggest that while health workers may have a protective effect on IMR, they may not be effective at preventing preterm/low birth weight births The third chapter of this dissertation uses municipality-level fixed effects analysis to examine the relationship between the state electoral cycle and allocation of health workers. We find that in election years, physician density increased by 0.01 physicians (p<0.001) and nurse density increased by 0.02 nurses (p<0.001) per 1,000 population, leading to an average increase of 33 new physicians and 77 new nurses per state compared to non-election years. This finding suggests the presence of an electoral budget cycle in allocation of health workers during the study period in Mexico. Considering the significant contribution that health workers can have at reducing IMR, understanding the decisions governing their allocation is an important area of study that could improve allocative efficiencies and child health outcomes.