Presenter:

M. Zia Sadique

Authors:

M. Zia Sadique, Mohammad Asadullah

Mon June 5, 2006 9:30-10:45 Room Alumni Lounge

Rationale: Vaccine preventable diseases account for considerable proportion of child deaths and morbidity in many developing countries. Understandably so, the expanded program of immunization (EPI), features one of the corner stones of public health program of most developing courtiers. These programs have brought considerable direct and indirect benefits to health and nutritional status of children. Despite these programmatic interventions, many developing countries have yet to achieve the target of Universal Childhood Immunisation of 80 percent, and in many situation immunisation uptake remains low posing the threat of disease outbreak very likely. It is extremely important for policy makers in developing countries to evaluate the contribution of public health programs which will help developing programs that are more effective in achieving their targets.

Objective:

The objective of the paper is to evaluate the contribution of a public health program on the demand for childhood vaccination by decomposing the direct and indirect channels through which public health program influences household demand for preventive health care.

Methodology: The paper aims to estimate household demand for child immunization in a rural area of Bangladesh where a maternal health care program known as Maternal and Child Health (MCH) Program is in operation. We exploit the existence of an exogenously assigned maternal health care program in the study area where households in the treatment area received important health facilities. Households in the control area were exposed to pubic health facilities only.

We focus on three immunisation/vaccination outcomes for the most recently born child for a sample of 1033 children: (i) no immunisation, (ii) partial immunisation and (iii) full immunisation. The empirical analysis employs Ordered Probit regressions where the dependent variable is defined jointly for all possible outcomes mentioned above.

While the multivariate analysis accounts for a host of demand side determinants of immunisation outcomes in the treatment and control areas, special attention is given to mother’s education and risk attitude, and their interaction with the program effect on immunisation behaviour.

Results:

The MCH program has significantly enhanced immunisation status of children - both directly and indirectly. Mother’s education has shown important influence over child health care choices related to immunisation. This positive effect is purely driven by the knowledge and awareness associated with maternal education. The results lead to confer that the MCH program acts as a substitute for maternal education as it has found to compensate low endowment of mothers education. Prenatal care visit has also significantly enhanced household’s demand for childhood immunization, where prenatal care proxies for both risk awareness of pregnant mothers and knowledge about health care choices. Public health program has reinforced the household’s risk awareness towards child health choices. These findings remain robust to control for household income leading to the conclusion that influence of maternal education and pre-natal health care choice are not proxying for an income effect.

Conclusion: Public health program has important spillover effects on child health and welfare which should be included in their evaluation.