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Public health spending on infant and child mortality in India during the years 1980—2006
Authors: Kaushalendra Kumar, Faujdar Ram, Abhishek Singh
Source: Lancet, Volume 381, Page S76, doi:10.1016/S0140-6736(13)61330-6
Topic(s): Childhood mortality
Infant mortality
Country: Asia
Published: JUN 2013
Abstract: Background India has achieved a substantial decline in its infant mortality rate from 110 to 47 deaths per 1000 in the last two decades. But, in 2011 there were still 1•7 million deaths in children under-5 in India, accounting for 24% of global under-5 child deaths. On the one hand, per-capita public spending on health has doubled during the same period, but out-of-pocket health expenditure still constitutes 70% of total health spending. In this context, the present study investigated the association between public health spending and infant and child mortality in India. Methods In the study, data from the first, second, and third National Family Health Survey were used to create a birth cohort for the years 1980 to 2006 that provided individual death history. The mortality data for each individual were merged with yearly state health expenditure, income, fiscal deficit, and the Gini coefficient for the 27 years, 1980—2006. As health expenditure varies over time by state but not by individual, a state-level fixed effects model was adopted for probit estimation, along with a time fixed effect probit estimation to give the time varying effect. Findings State-level fixed effect regression results show public spending on health has a marginal effect of -0•077 (SE 0•021) on infant mortality and -0•126 (0•025) on under-5 mortality. Marginal effects of per-capita income and its distribution are statistically insignificant in a state-level fixed model, but they become significant in a time fixed model. Mother's education and age at the birth of the child are significant determinants of infant and under-5 mortality in both of the specified models. Interpretation Even though overall public health expenditure has a marginal effect, its effect is greater on under-5 mortality than on infant mortality. Maternal characteristics, such as age at the birth of the child and education, are significantly associated with infant and child mortality. Given the large variation in public health expenditure across the state, this study suggests that a substantial targeted investment in public health is required to improve health outcomes in the laggard states of India.