Child Health Outcome Inequalities in Nepal

  • Purna Bahadur Khand Pokhara University, Pokhara - 30, NEPAL
  • Lalita Chanwongpaisarn University of the Thai Chamber of Commerce, Bangkok 10400, THAILAND
Keywords: Infant death, health outcome inequality, concentration index, decomposition of inequality, change in the decomposition of inequality

Abstract

This study aimed to quantify child health outcome inequalities in neonatal death and explore major contributors to the inequalities for the periods 1991-1995, 1996-2000, 2001-2005, 2006-2010 and 2011-2015 in Nepal using data from Nepal Demographic and Health Surveys conducted in 1996, 2001, 2006, 2011 and 2016 respectively. Concentration index was used to measure the inequalities and decomposition of the index was performed to explore major sources of the inequalities. Results showed that there were substantial neonatal death inequalities between the poor and better-off which concentrated more on disadvantaged groups for all survey periods in spite of highly prioritized newborn policies. The neonatal inequality was slightly narrowed in the second survey but worsened continuously for the last three surveys. Decomposition analysis evidenced that mother education was the largest contributor to the inequalities though there was an increasing trend of women literacy rate. Other major contributors were ecological zones and birth order. Results obtained from this study would be useful information for health policymakers in Nepal.

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References

Arokiasamy, P., & Pradhan, J. (2011). Measuring wealth-based health inequality among Indian children: the importance of equity vs efficiency. Health Policy and Planning, 26, 429–440.
Becker, G. S. (1964). Human Capital: a theoretical and empirical analysis, with special reference to education. New York: Columbia University Press.
Bloom, D. E., & Canning, D. (2000). The Health and Wealth of Nations. Science, 287 (18), 1207-1209.
Bryce, J., Terreri, N., Victora, C. G., Mason, E., Daelmans, B., Bhutta, Z. A., Bustreo, F., Songane, F., Salama, P. & Wardlaw, T. (2006). Countdown to 2015: tracking intervention coverage for child survival. The Lancet, 368, 1067–1076.
CBS. (2016). Annual Household Survey 2014/15. Kathmandu: Central Bureau of Statistics.
CBS. (2011). Nepal Living Standards Survey, 2010/11: Statistical Report, Volume One. Kathmandu, Nepal: Central Bureau of Statistics.
CBS. (2011). Nepal Living Standards Survey, 2010/11: Statistical Report, Volume Two. Kathmandu, Nepal: Central Bureau of Statistics.
Dhanaraj, S. (2015). Determinants of Child Health: An Empirical Analysis. Madras School of Economics Working Paper 136.
Grossman, M. (1972). On the Concept of Health Capital and the Demand for Health. Journal of Political Economy, 80 (2), 223-255.
Gwatkin, D. R. (2000). Health inequalities and the health of the poor: what do we know? what can we do? Bulletin of the World Health Organization, 78 (1), 3-17.
Hosseinpoor, A. R., Van Doorslaer, E., Speybroeck, N., Naghavi, M., Mohammad, K., Majdzadeh, R., et al. (2006). Decomposing socioeconomic inequality in infant mortality in Iran. International Journal of Epidemiology, 35, 1211-1219.
Jacobson, L. (2000). The Family as Producer of Health: An Extended Grossman Model. Journal of Health Economics, 19 (5), 611-637.
Kakwani, N., Wagstaff, A., & Van Doorslaer, E. (1997). Socioeconomic inequalities in health: Measurement, computation, and statistical inference. Journal of Econometrics, 77, 87-103.
MoHP. (2015). Nepal Health Sector Strategy 2015–2020. Kathmandu: Ministry of Health and Population.
MoHP, New Era & ICF. (2012). Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population, New ERA and ICF International.
MoHP, New Era & ICF. (2017). Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: Ministry of Health and Population.
Moser, K., Leon, D., & Gwatkin, D. (2005). How Does Progress Towards the Child Mortality Millennium Development Goal Affect Inequalities between the Poorest and Least Poor? Analysis of Demographic and Health Survey Data. British Medical Journal 331, 1180–1183.
Mosley, W.H. & Chen, L.C. (1984). An Analytical Framework for the Study of Child Survival in Developing Countries. Population and Development Review, 10, 25-45.
Mushkin, S. J. (1962). Health as an Investment. Journal of Political Economy, 70, 129-157.
NPC. (2016). Nepal and the Millennium Development Goal Final Status Report 2000-2015. Kathmandu: National Planning Commission.
O'Donnell, O., Doorslaer, V., Wagstaff, A., & Lindelow, M. (2008). Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. Washington, D.C.: The World Bank.
Pande, R., & Yazbeck, A. (2003). What's in the country average? Wealth, gender, and regional inequalities in immunization in India. Social Science & Medicine, 57, 2075–2088.
Rarani, M. A., Rashidian, A., Khosravi, A., Arab, M., Abbasian, E., & Morasae, E. K. (2017). Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis. International Journal of Policy Management, 6 (4), 219-228.
Regidor, E. (2004a). Measures of health inequalities: part 1. Journal of Epidemiol Community Health, 58, 858-861.
Regidor, E. (2004b). Measures of health inequalities: part 2. Journal of Epidemiol Community Health, 58, 900-903.
Rosenzweig, M. R., & Schultz, T. P. (1982). The Behavior of Mothers as Inputs to Child Health: The Determinants of Birth Weight, Gestation, and Rate of Fetal Growth. National Bureau of Economic Research.
Schultz, T.P. (1984). Studying the Impact of Household Economic and Community Variables on Child Mortality. Population and Development Review, 10, 215-235.
Van Doorslaer, E., & Koolman, X. (2004). Explaining the differences in income-related health inequalities across European countries. Health Economics, 13, 609-628.
van Doorslaer, E., Wagstaff, A., Bleichrodt, H., Calonge, S., Gerdtham, U., Gerfin, M., et al. (1997). Income-related inequalities in health: some international comparisons. Journal of Health Economics, 16, 93-112.
Wagstaff, A. (1986). The Demand for Health. Journal of Health Economics, 5, 195-233.
Wagstaff, A., & van Doorslaer, E. (1994). Measuring Inequalities in Health in the Presence of Multiple-Category Morbidity Indicators. Health Economics, 3, 281-291.
Wagstaff, A., Paci, P., & Van Doorslaer, E. (1991). On the Measurement of Inequalities in Health. Social Science and Medicine, 33 (5), 545-557.
Wagstaff, A., Van Doorslaer, E., & Watanabe, N. (2003). On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. Journal of Econometrics, 112, 207 – 223.
Yiengprugsawan, V., Lim, L. L., Carmichael, G. A., Dear, K. B., & Sleigh, A. C. (2010). Decomposing socioeconomic inequality for binary health outcomes: an improved estimation that does not vary by choice of reference group. BMC Research Notes, 3, 57-61.
Published
2019-08-31