Dissertation/Thesis Abstract

The effects of household and community-based interventions: Evidence from Indonesia
by Triyana, Margaret M., Ph.D., The University of Chicago, 2013, 188; 3568431
Abstract (Summary)

Low birth weight is a global health problem, especially in developing countries. Approximately 16% of all new-borns in developing countries were born with low birth weight. Motivated by this troublesome fact, this research evaluates policies that target maternal and children's health in low-resource settings. The following three essays analyze community-based and household-based health interventions. Program evaluation is important to inform future policy, and more importantly, to compare policies in order to determine the most effective strategies to improve birth outcomes in developing countries. Indonesia has implemented both community-based and household-based interventions. The three essays in this research evaluate the following three programs. The first two essays evaluate two recent programs: a household-based program, Program Keluarga Harapan (PKH), and a community-based program, PNPM Generasi Sehat dan Cerdas (Generasi ). The third essay evaluates the 'Midwife in the Village' ( Bidan di Desa) program. The 'Midwife in the Village' program is a community-based program that was implemented in the 1980s to provide each village with a trained midwife to provide prenatal care and delivery assistance. The other two programs, PKH and Generasi, were piloted in 2007. PKH is a household Conditional Cash-Transfer (CCT) program, while Generasi, functions a community CCT program; the community CCT program provides villages with block grants to fund activities that promote health and education.

The first essay analyzes the effects of Indonesia's household CCT program on the price and quality of health care services, and how these changes affect poor households. In this paper, I focus on price changes in the health care market because it is directly affected by the program and health care providers may increase prices in response to increased demand. The program is associated with higher utilization of health care, driven by increased utilization among the poor, who also experience higher quality of care. The quality improvement in the target population is driven by increased utilization, and not an improvement in quality at the local health care market. In response to the demand shock from the CCT program, I find a price increase in sub-districts that are randomized into treatment, which suggests the importance of supply response in demand-side interventions.

The second essay compares the relative effectiveness of household CCT and community CCT programs in improving birth outcomes in similar communities. Both programs have been shown to improve health-seeking behavior, but it has not been established whether these indicators translate into improved birth outcomes. To select comparable communities, the sample is restricted to areas with similar characteristics using propensity score matching. Under matching, both programs increase health seeking behavior, but there is no significant change in low birth weight. However, the household CCT program reduces preterm birth. The matching estimates suggest that the targeted household CCT program is more effective in improving birth outcomes than the broad community-based program, even though both programs improve health-seeking behavior.

The third essay analyzes the impact of the 'Midwife in the Village' program in rural Indonesia. In this essay, I extend earlier research by Frankenberg and Thomas (FT, 2001) on the effect of gaining a midwife in the village. FT find improvements in women's health status and birth weight. Using additional data, this essay estimates the longer term effect of midwife presence and the effect of losing the village midwife after the 1998 financial crisis. The effects of gaining a midwife are qualitatively similar to FT's estimates, but they are not statistically significant, which suggests that the program effects diminish over time. I find that losing a midwife has no statistically significant effect on women's health status or low birth weight. These results suggest that the program was effective in maintaining the health status of rural communities.

Indexing (document details)
Advisor: Lalonde, Robert J.
Commitee: Black, Dan, Charles, Kerwin K., Marinescu, Ioana E.
School: The University of Chicago
Department: Public Policy Studies
School Location: United States -- Illinois
Source: DAI-A 74/11(E), Dissertation Abstracts International
Subjects: Public policy
Keywords: Child health, Community-based program, Health care provision, Household conditional cash transfer, Indonesia, Maternal health, Midwives
Publication Number: 3568431
ISBN: 9781303229275
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