Monitoring health services delivery: Evidence from civil conflict in Nepal. (October 2021)

• Record Type: Journal Article
• Authors: Raut, Nirmal Kumar; Tanaka, Ryuichi
• Is Part Of: World development. Volume 146(2021)
• Publication Date: 2021-10
• Subjects: Conflict -- Healthcare status -- Monitoring -- Culture; Economic history -- 1990- -- Periodicals; Economic assistance -- Developing countries -- Periodicals; 330.9
• DOI: 10.1016/j.worlddev.2021.105543
• Languages: English
• ISSNs: 0305-750X

Abstract

Highlights: This paper explores the short- and medium-term health consequences of moderate-intensity conflicts. Results show short-term improvement in health status while short- and medium-term increase in healthcare utilization. The study unfolds the role of exposure to new social norms through civil conflicts in changing people's behavior. The results suggest regular monitoring of public services provisions may result in ensuring qualified public services. Abstract: The effects of armed conflict on delivery of public services such as health and education is a contested issue. Poor health and education have important consequences on the process of human capital formation. We analyze the short- and medium-term effects of the civil conflict in Nepal from 1996 to 2006 on individual health status and institutional healthcare utilization. Using three waves of nationally representative household surveys before, during, and after the conflict period and by exploiting district level variations in the exposure to conflict, measured by the number of conflict-related casualties, we estimate the relationship between armed conflict and individual health status and healthcare utilization during and after the conflict period. Our estimates using the difference-in-differences approach reveal that conflict is associated with short-term improvement in individual health status: a one standard-deviation increase in conflict-related casualties is associated with an approximately 4-percentage point improvement in individual health status, as measured by the incidence of sickness. We find that conflict is associated with both short- and medium-term increases in healthcare utilization; a one standard-deviation increase in conflict-related casualties is associated with an approximately 10-percentage point improvement in individual healthcare utilization probability. We provide evidence for the possible mechanisms of these conflict health associations. We find that improvements in the quality of healthcare services, particularly through Maoists' monitoring of staff absenteeism in healthcare facilities, has led to better health outcomes in conflict-intense areas. These findings suggest that monitoring improves the quality of public services provisions and, therefore, is an important tool to ensure the resilience of human capital formation process in conflict-hit societies.