Managing Health Outcomes through Local Governance

Has the devolution of responsibilities and finances to local governments in India produced positive impacts on health status and incomes of men and women? Using a national data set with details on health, health seeking behavior and local governance, we estimate a system of simultaneous equations to analyze the incidence of illness via a health production function and show that health care expenditures at the household level, choice of health care provider by members, and the incidence of illness will jointly impact individual incomes. The incidence of illness is significantly reduced by better access to drinking water, clean surroundings and awareness about health campaigns. Discussions of health issues in the Gram Sabha reduce illnesses for both men and women and their private health expenditures. Reserving the position of the village head to women leads to greater participation in Gram Sabha meetings; better problem resolution in water supply, sanitation and health; greater village health expenditures; and greater satisfaction with access to health. The increased expenditures of Panchayats on health care reduce the incidence of illness three times more for women than for men, but reduce their private health care expenditures about equally. It also shifts the choice of health care providers from private to public facilities, more so for women than for men. Family inheritance increase the use of private health care for both genders, while a woman’s individual land inheritance increases her use of both public and private health care. While women do not have lower access to health care or are discriminated within the household in terms of access to different providers, their earnings are adversely affected to a greater degree by illness compared to that of men. Women’s private health expenditures tend to improve their incomes more compared to that of men.

Hans P. Binswanger-Mkhize, Hari K. Nagarajan, Kailash Chander Pradhan
May 2012