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Field
Abstract
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Before
Despite a multitude of programs aimed at improving supply of primary health care providers in underserved communities, there is little convincing micro-evidence about the relationship between primary care provider supply and outcomes. In this study we circumvent thorny identification issues by randomly assigning primary care providers to health facilities and communities. 180 primary health care facilities in Nigeria are participating in this study. Two-thirds of these facilities will be randomly assigned an extra primary care provider (in addition to existing providers) who will practice there for a year. The remaining one-third will maintain the status quo and serve as a control group. We further examine whether the 'quality' of the assigned provider matters for outcomes. A relevant and easily observable proxy of quality is whether or not the provider is a doctor. Within the group of facilities assigned to receive an additional provider, we randomly assign one-half to receive a doctor while the other half receive a mid-level provider similar in skill level to existing providers in the facility. Within this trial, we embed a maternal conditional cash transfer intervention in which pregnant women can receive up to $16 if they attend antenatal and postnatal care, and deliver in the study health facility. Approximately half of participating women are assigned to this cash transfer arm while the other half are assigned to a control arm. We study the effect of the cash transfer on maternal health-seeking behavior and on maternal and newborn outcomes. We exploit the exogenous increase in use of medical care induced by the cash transfer to estimate the returns to health provider human capital.
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After
Despite a multitude of programs aimed at improving supply of primary health care providers in underserved communities, there is little convincing micro-evidence about the relationship between primary care provider supply and outcomes. In this study we circumvent thorny identification issues by randomly assigning primary care providers to health facilities and communities. 180 primary health care facilities in Nigeria are participating in this study. Two-thirds of these facilities will be randomly assigned an extra primary care provider (in addition to existing providers) who will practice there for a year. The remaining one-third will maintain the status quo and serve as a control group. We further examine whether the 'quality' of the assigned provider matters for outcomes. A relevant and easily observable proxy of quality is whether or not the provider is a doctor. Within the group of facilities assigned to receive an additional provider, we randomly assign one-half to receive a doctor while the other half receive a mid-level provider similar in skill level to existing providers in the facility. Within this trial, we embed a maternal conditional cash transfer intervention in which pregnant women can receive up to $16 if they attend antenatal and postnatal care, and deliver in the study health facility. Approximately half of participating women are assigned to this cash transfer arm while the other half are assigned to a control arm. We study the effect of the cash transfer on maternal health-seeking behavior and on maternal and newborn outcomes.
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Field
Additional Keyword(s)
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Before
health workers, supply
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After
health workers, supply, cash transfers
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