Pro-poor birth coverage and child health in Africa

ABSTRACT

This paper explores which African countries had relatively low rates of underweight children and relatively high birth coverage (percentage of births with a skilled attendant) in the poorest quintile. Swaziland and Rwanda emerged as relatively ‘pro-poor’ in that both measures were more than one standard deviation better than predicted by GDP per capita. Unlike Swaziland, Rwanda’s status as an outlier was eliminated in regressions controlling also for urbanisation, medical professionals per 1000 people and health spending, suggesting that its pro-poor outcomes were related to these factors. AIDS funding may have helped Swaziland provide primary health care to the poor, but its high birth coverage preceded the HIV epidemic. Although relatively pro-poor in international terms, Swaziland and Rwanda emerged as relatively unequal by the CIX measure of health inequality with regard to percentage of underweight children across quintiles. It is important not to conflate relatively equal with relatively pro-poor health outcomes.

KEYWORDS:

• Africa and Swaziland
• health inequality
• pro-poor
• birth coverage
• child underweight

Disclosure Statement

No potential conflict of interest was reported by the author.

Notes

1 http://www.who.int/gho/health_equity/en/ (data downloaded January 2016).

2 As there is a strong correlation between the log of infant mortality and the log of children underweight (0.78 in Africa and 0.75 in the full sample), we used it to predict values for underweight children in six countries where data exist on infant mortality by quintile, but not on child underweight (Comoros, Indonesia, Madagascar, Philippines, South Africa and Ukraine).

3 http://data.worldbank.org/data-catalog/world-development-indicators

4 http://www.aho.afro.who.int/profiles_information/index.php/Swaziland:Service_delivery_-_The_Health_System#Organization_and_management_of_health_services

Additional information

Funding

This paper is a product of the ‘Legislating and Implementing Welfare Policy Reforms’ research project funded by the Economic and Social Research Council (ESRC) and Department for International Development (DfID) in the United Kingdom. UKAid through ESRC, grant ES/J018058/1.