A new and important paper by Anne Case and Christina Paxson finds the following:
We document the impact of the AIDS crisis on non-AIDS related health services in fourteen sub-Saharan African countries. Using multiple waves of Demographic and Health Surveys (DHS) for each country, we examine antenatal care, birth deliveries, and rates of immunization for children born between 1988 and 2005. We find deterioration in nearly all of these dimensions of health care over this period. The most recent DHS survey for each country collected data on HIV prevalence, which allows us to examine the association between HIV burden and health care. We find that erosion of health services is highly correlated with increases in AIDS prevalence. Regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions currently shouldering the heaviest burdens have seen the largest erosion in treatment for pregnant women and children. Using semi-parametric techniques, we can date the beginning of the divergence in health services between high and low HIV regions to the mid-1990s.
Case and Paxson are unable to pin down a mechanism for why this is happening. They suggest it is not driven by an erosion of wealth (though the data they use is somewhat lacking in measures of health beyond asset ownership) or reduced demand for medical care by HIV+ mothers. On the other hand, they cannot rule out adverse impacts of HIV/AIDS on the supply of health care workers and/or the diversion of resources to those with HIV/AIDS, perhaps at the expense of other aspects of medical care. As such, the authors rightly point out that there is more work to be done and that this work needs to be done very soon.
I'll have more to say about this in a forthcoming post.
3 comments:
How is this any different than Karen Grepin's paper?
I'll talk more about the paper in question in a later post. The difference is that the paper discussed here focuses on HIV prevalence as the main independent while Grepin focuses on AID flows.
Furthermore, Case and Paxson are not convinced that the aid explanation can account for all the trends in the data. From the working paper:
"However, it is unlikely that the expansion of AIDS-targeted
foreign aid explains a large part of what we see in our data. Grépin’s numbers indicate that
foreign aid for AIDS grew little until the year 2000, and then escalated rapidly as funds for ART
became available through PEPFAR and other programs. This pattern is consistent with increases
in access to ART. The number of people in Sub-Saharan Africa receiving ART is estimated to
have been only 100,000 in 2003, but then rose to 1.375 million in 2006, and 2.12 million in 2007
(World Health Organization, 2008). Our results indicate that the divergence in the quality of
care between high- and low-AIDS regions began in the early- to mid-1990’s, before foreign aid
for AIDS was significant, and when very few Africans were receiving ART. The expansion of
ART is so recent that the data needed to examine its effects on health services are not yet
available."
This is interesting -- I clearly don't know this literature well.
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