Herrera-Almanza Catalina, Rosales-Rueda Maria F
Department of Agricultural and Consumer Economics,University of Illinois, Urbana-Champaign, United States.
Department of Economics, Rutgers University, United States.
J Health Econ. 2020 Sep;73:102365. doi: 10.1016/j.jhealeco.2020.102365. Epub 2020 Aug 27.
Distance to health centers can represent a significant healthcare cost for poor households. Community-based health interventions and community health workers can be an alternative to deficient formal health care provision among remote populations. We analyze the effects on fertility outcomes of a large-scale community-based health worker program that aims to reach remote areas distant from health facilities in Madagascar. We use a triple difference model that exploits time and geographic variation in the program rollout and the geocoded household distance to the closest health facility. Our findings indicate that the program decreased the probability of conception among women in treated areas but did not have a differential effect among women living in remote areas. A potential mechanism underlying this fertility reduction is that the program increased women's modern contraceptive use.
距离健康中心较远可能对贫困家庭造成高昂的医疗成本。基于社区的健康干预措施以及社区卫生工作者可以作为偏远地区正规医疗服务不足的一种替代方案。我们分析了一项大规模的基于社区的卫生工作者项目对生育结果的影响，该项目旨在覆盖马达加斯加远离医疗机构的偏远地区。我们使用了一种三重差分模型，该模型利用了项目推广过程中的时间和地理差异以及家庭到最近医疗机构的地理编码距离。我们的研究结果表明，该项目降低了受治疗地区女性怀孕的概率，但对生活在偏远地区的女性没有产生差异影响。生育率降低的一个潜在机制是该项目增加了女性对现代避孕方法的使用。
