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Original research
The impact of a health facility construction campaign on health service utilisation and outcomes: analysis of spatially linked survey and facility location data in Ethiopia
  1. Kevin Croke1,
  2. Andualem Telaye Mengistu2,
  3. Stephen D. O'Connell3,
  4. Kibrom Tafere4
  1. 1Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  2. 2Policy Studies Institute, Addis Ababa, Ethiopia
  3. 3Department of Economics, Emory University, Atlanta, Georgia, USA
  4. 4Development Economics Group, World Bank Group, Washington, DC, USA
  1. Correspondence to Dr Kevin Croke; kcroke{at}hsph.harvard.edu

Abstract

Background Access to health facilities in many low-income and middle-income countries remains low, with a strong association between individuals’ distance to facilities and health outcomes. Yet plausibly causal estimates of the effects of facility construction programmes are rare. Starting in 2004, more than 2800 government health facilities were built in Ethiopia. This study estimates the impact of this programme on maternal health service utilisation and birth outcomes.

Methods We analyse the impact of Ethiopia’s health centre construction programme on health service utilisation and outcomes, using a difference-in-difference design. We match facility opening years to child birth years in four rounds of Demographic and Health Surveys (DHS) using georeferenced data. We also use event study models to test for pre-trends in the outcomes of interest.

Results Opening of new health facilities within 5 km increases facility delivery by 7.2 percentage points (95% CI 5.2 to 9.1) and antenatal care by 0.38 visits (95% CI 0.24 to 0.52). It is not significantly associated with changes in caesarean section births or neonatal mortality. Opening of district hospitals increases facility delivery by 18.2 percentage points (95% CI 12.7 to 23.7), and caesarean section births by 6.8 percentage points (95% CI 2.5 to 11.2), but is not associated with reduction of neonatal mortality.

Conclusions Ethiopia’s facility construction program improved access to antenatal and delivery care. However, there was no detectable association between facility construction and neonatal mortality. Increased access to care must be combined with health system quality improvements and broader social development initiatives to sustainably improve health outcomes.

  • health economics
  • health systems evaluation
  • maternal health
  • health policy
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2020-002430

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    Footnotes

    • Handling editor Sanni Yaya

    • Contributors All authors contributed equally to the paper.

    • Funding World Bank Development Economics Group Research Support Budget and Harvard T.H. Chan School of Public Health Dean’s Fund for Scientific Advancement.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All DHS data are freely available from measuredhs.com. Facility location data was obtained from Ethiopia Public Health Institute (EPHI). The authors are not at liberty to share this data, but it can be requested from EPHI.