Background
Methods
Data and variable description
Sierra Leone Integrated Household Survey (SLIHS)
Demographic and Health Survey (DHS)
Estimation strategy
The Regression Discontinuity Design
Time Trend-adjusted Before-After Estimation Approach
Results
Impact on utilisation and out-of-pocket health expenditure in children under 5 years
(1) | (2) | (3) | (4) | |
---|---|---|---|---|
Eligible children | Non-eligible children | Difference (2) – (1) | All study children | |
Child Characteristics | ||||
Age in years | 2.264 | 7.355 | 5.09***
| 4.944 |
Male | 0.544 | 0.525 | −0.019 | 0.534 |
Household Characteristics | ||||
Rural | 0.644 | 0.683 | 0.039 | 0.665 |
Western region | 0.123 | 0.0948 | −0.028 | 0.108 |
Eastern region | 0.128 | 0.136 | 0.008 | 0.132 |
Northern region | 0.422 | 0.474 | 0.052*
| 0.449 |
Southern region | 0.327 | 0.296 | −0.032 | 0.311 |
Household size | 6.921 | 7.113 | 0.192 | 7.022 |
Household total expenditure per capita (US$) | 293.8 | 276.2 | −17.60 | 284.6 |
Head of Household Characteristics | ||||
Married | 0.851 | 0.865 | 0.014 | 0.859 |
Age | 43.22 | 45.33 | 2.11***
| 44.33 |
Male | 0.759 | 0.748 | −0.01 | 0.753 |
Christian | 0.175 | 0.157 | −0.017 | 0.165 |
No education | 0.693 | 0.752 | 0.059**
| 0.724 |
Observations | 761 | 872 | 1633 |
Simple linear | Linear interaction | Quadratic interaction | |
---|---|---|---|
Utilisation (LPM) | |||
ITT effect (Age ≥ 5 years) | −0.0310 | −0.0197 | 0.0885 |
(0.060) | (0.061) | (0.098) | |
N
| 1633 | 1633 | 1633 |
AIC
| 2235.2 | 2236.5 | 2234.3a
|
Probability of reporting zero consultation and prescription expenditure (LPM) | |||
ITT effect (Age ≥ 5 years) | −0.134*
| −0.142**
| −0.0938 |
(0.071) | (0.071) | (0.116) | |
N
| 915 | 915 | 915 |
AIC
| 1180.8a
| 1182.3 | 1186.0 |
Probability of reporting zero consultation expenditure (LPM) | |||
ITT effect (Age ≥ 5 years) | −0.121*
| −0.126*
| −0.0359 |
(0.073) | (0.072) | (0.113) | |
N
| 915 | 915 | 915 |
AIC
| 1136.5a
| 1138.3 | 1141.2 |
Probability of reporting zero prescription expenditure (LPM) | |||
ITT effect (Age ≥ 5 years) | −0.0410 | −0.0628 | −0.0600 |
(0.058) | (0.059) | (0.095) | |
N
| 915 | 915 | 915 |
AIC
| 1005.8 | 1003.9a
| 1007.8 |
Total expenditure (two-part model showing marginal effects) | |||
ITT effect (Age ≥ 5 years) | −0.144 | −0.0827 | −0.623 |
(0.462) | (0.436) | (1.753) | |
N
| 915 | 915 | 915 |
AIC
| 686.0 | 685.94 | 685.93a
|
Impact on formal private and informal/other health care service use
Formal private | Informal private/others | |||||
---|---|---|---|---|---|---|
Simple linear | Linear interaction | Quadratic interaction | Simple linear | Linear interaction | Quadratic interaction | |
Utilisation (LPM) | ||||||
ITT effect (Age ≥ 5 years) | −0.0286 | −0.0377 | −0.0875 | 0.0995**
| 0.105**
| 0.0526 |
(0.031) | (0.033) | (0.069) | (0.050) | (0.050) | (0.083) | |
N
| 1633 | 1633 | 1633 | 1633 | 1633 | 1633 |
AIC
| 566.7a
| 567.4 | 568.2 | 1774.2a
| 1776.0 | 1779.3 |
Probability of reporting zero consultation and prescription expenditure (LPM) | ||||||
ITT effect (Age ≥ 5 years) | 0.0946 | 0.0980 | 0.0902 | 0.00674 | −0.0694 | −0.0659 |
(0.197) | (0.193) | (0.339) | (0.081) | (0.094) | (0.146) | |
N
| 152 | 152 | 152 | 465 | 465 | 465 |
AIC
| 226.0a
| 228.0 | 231.9 | 519.6 | 518.6a
| 522.3 |
Total expenditure (two-part model showing marginal effects) b
| ||||||
ITT effect (Age ≥ 5 years) | −0.948 | −1.104 | −139.1 | 0.190 | 0.245 | −3.891 |
(1.239) | (1.525) | (308.367) | (0.201) | (0.194) | (10.624) | |
N
| 152 | 152 | 152 | 465 | 465 | 465 |
AIC
| 626.9 | 624.5 | 618.4a
| 419.6 | 419.1 | 417.1a
|
Impact on maternal health seeking behaviours
Variables | Pre-FHCI | Post-FHCI | Difference (Post-Pre) | All |
---|---|---|---|---|
ANC Outcome Variablesa
| ||||
Received skilled ANC during pregnancy | 0.963 | 0.973 | 0.01 | 0.968 |
ANC received at public facility | 0.955 | 0.969 | 0.014 | 0.964 |
Four ANC visits at public facility | 0.751 | 0.771 | 0.02 | 0.508 |
Obs.
|
2685
|
5630
|
8315
| |
PNC Outcome Variables | ||||
Health Facility for Delivery | ||||
Government facility | 0.447 | 0.501 | 0.054 | 0.479 |
Government hospital | 0.12 | 0.134 | 0.014 | 0.129 |
Government health centre | 0.329 | 0.369 | 0.04 | 0.352 |
Private facility | 0.017 | 0.018 | 0.001 | 0.017 |
Delivery with skilled health worker | 0.584 | 0.636 | 0.052 | 0.616 |
Postnatal care within 48 h of birth in public facility | 0.121 | 0.266 | 0.145 | 0.208 |
Vitamin A given within 2 months of delivery | 0.816 | 0.788 | −0.028 | 0.813 |
3 courses of DPT received within 12 months of delivery (DPT3) b
| 0.609 | 0.625 | 0.016 | 0.691 |
Obs.
|
3968
|
7970
|
11,938
| |
Covariates | ||||
Age | 30.5 | 28.38 | −2.12 | 29.34 |
Urban | 0.315 | 0.302 | −0.013 | 0.308 |
Christian | 0.19 | 0.187 | −0.003 | 0.19 |
Mother’s education | ||||
Primary education | 0.127 | 0.142 | 0.015 | 0.133 |
Secondary education | 0.136 | 0.184 | 0.048 | 0.164 |
Higher education | 0.016 | 0.01 | −0.006 | 0.012 |
Asset index quintile | ||||
Lowest | 0.232 | 0.232 | 0 | 0.233 |
Second | 0.194 | 0.2 | 0.006 | 0.199 |
Middle | 0.204 | 0.202 | −0.002 | 0.199 |
Fourth | 0.215 | 0.22 | 0.005 | 0.218 |
Highest | 0.155 | 0.147 | −0.008 | 0.15 |
Eastern Region | 0.228 | 0.213 | −0.015 | 0.221 |
Northern Region | 0.384 | 0.396 | 0.012 | 0.385 |
Southern Region | 0.279 | 0.277 | −0.002 | 0.281 |
Western Region | 0.11 | 0.114 | 0.004 | 0.113 |
Model 1 (M1) | Model 2 (M2) | LL test (M2 vs. M1) | |||
---|---|---|---|---|---|
May’10 | June’10a
| May’10 | June’10 | ||
Antenatal care (ANC) visits in public facilitiesb
| |||||
Coefficients
| |||||
Time trend | 0.016 | 0.019*
| |||
Policy | 0.282**
| 0.245*
| 1.066**
| 1.059*
| |
Policy * Time trend | −0.026*
| −0.029*
| |||
Marginal effects (%)
| |||||
Policy | 1.0*
| 0.8*
| 4.2 | 4.1 | 3.38 |
Four ANC visits in public facilities (ANC4)b
| |||||
Coefficients
| |||||
Time trend | 0.004 | 0.003 | |||
Policy | 0.118*
| 0.125**
| 0.260 | 0.396 | |
Policy * Time trend | −0.005 | −0.007 | |||
Marginal effects (%)
| |||||
Policy | 2.0*
| 2.2**
| 4.6 | 7.0 | 0.7 |
Delivery in public facility | |||||
Coefficients
| |||||
Time trend | 0.012*
| 0.006 | |||
Policy | 0.231***
| 0.295***
| 0.208*
| 0.330**
| |
Policy * Time trend | −0.007 | −0.005 | |||
Marginal effects (%)
| |||||
Policy | 4.8***
| 6.1***
| 4.3*
| 6.8**
| 9.34 |
Delivery in private facilityc
| |||||
Coefficients
| |||||
Time trend | 0.002 | 0.009 | |||
Policy | 0.081 | 0.081 | −0.236 | −0.410 | |
Policy * Time trend | 0.007 | 0.005 | |||
Delivery with trained health workerd
| |||||
Coefficients
| |||||
Time trend | 0.014**
| 0.005 | |||
Policy | 0.241***
| 0.310***
| 0.135 | 0.263*
| |
Policy * Time trend | −0.007 | −0.002 | |||
Marginal effects (%)
| |||||
Policy | 4.6***
| 6.0***
| 2.6 | 5.1*
| 16.87 |
Postnatal care within 48 h | |||||
Coefficients
| |||||
Time trend | 0.033***
| 0.034***
| |||
Policy | 1.046***
| 1.072***
| 0.635***
| 0.814***
| |
Policy * Time trend | −0.013 | −0.017**
| |||
Marginal effects (%)
| |||||
Policy | 14.1***
| 15.2***
| 9.1***
| 11.7***
| 89.8 |
Vitamin A given postnatally | |||||
Coefficients
| |||||
Time trend | 0.002 | 0.002 | |||
Policy | 0.035 | −0.081 | 0.782***
| 0.924***
| |
Policy * trend | −0.022*
| −0.024**
| |||
Marginal effects (%)
| |||||
Policy | 0.5 | −1.2 | 13.2***
| 15.6***
| 116 |
Infant DPT full coursee, f
| |||||
Coefficients
| |||||
Time trend | 0.026***
| 0.026***
| |||
Policy | 0.670***
| 0.671***
| 0.536***
| 0.727***
| |
Policy * Time trend | −0.014 | −0.019**
| |||
Marginal effects (%)
| |||||
Policy | 13.4***
| 13.3***
| 11.0***
| 14.0***
| 574 |