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Assessing Regional Variations in the Effect of the Removal of User Fees on Institutional Deliveries in Rural Zambia

Chitalu Chama-Chiliba () and Steven Koch ()
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Chitalu Chama-Chiliba: Department of Economics, University of Pretoria

No 201417, Working Papers from University of Pretoria, Department of Economics

Abstract: This paper examines regional differences in the effect of user fee removal in rural areas of Zambia on the use of health institutions for delivery. The analysis uses quarterly longitudinal data covering 2003q1-2008q4. When unobserved heterogeneity, spatial dependence and quantitative supply-side factors are incorporated in the Interrupted Time Series (ITS) design, user fee removal is found to immediately increase aggregate institutional deliveries, although the national trend was unaffected. Drug availability and the presence of traditional birth attendants also influence institutional deliveries at the national level, such that, in the short-term, strengthening and improving community-based interventions could increase institutional deliveries. However, there is significant variation and spatial dependence masked in the aggregate analysis. The results highlight the importance of service quality in promoting institutional deliveries, and also suggest that social and cultural factors, especially in rural areas, influence the use of health facilities for delivery. These factors are not easily addressed, through an adjustment to the cost of delivery in health facilities.

Keywords: Maternal care; Institutional deliveries; User fees; Spatial dependence (search for similar items in EconPapers)
JEL-codes: I10 I18 I19 R10 R15 R58 (search for similar items in EconPapers)
Pages: 38 pages
Date: 2014-04
New Economics Papers: this item is included in nep-afr and nep-ure
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