EMPIRICAL ESSAYS ON HEALTH ECONOMICS IN AFRICA

This thesis presents empirical evidence on two thematic but related health economics issues for countries in sub-Saharan Africa--a region which trails in many of the world's economic and social indicators. Primarily, investments in human capital--education and health--stimulate opportunities needed for the growth and enhancement of a skilled and healthy labour force. On the one hand, education enables young people to acquire skills to take up high quality jobs and embrace new opportunities needed to boost economic growth. On the other hand, investments in the health systems by way of strengthening and improving the capacities would help address the health needs of children and adults in the region. Subsequently, children can grow into healthy and better adults for whom their contribution to future economic development can be guaranteed. As a result, adverse health shocks in early childhood can have harmful adult consequences particularly in developing countries because of limited mitigating health infrastructures. Improving child health therefore is critical for the development of economies and one potential policy instrument which has been identified is maternal education. However, estimating the effect of maternal education on child health without accounting for the potential endogeneity issues that plague the relationship would not be able to uncover the causal effect. Therefore, the first chapter of the thesis is devoted to estimating the effect of reducing the length of education cycles of mothers on their fertility and children's health by using a comprehensive schooling reform as an instrument for education in Ghana. In 1987, the Ghana government undertook a comprehensive reform in the education sector primarily aimed at addressing the increasing inequities particularly between secondary school and middle school by ensuring that all children of school age had access to higher education. As a consequence, pre-tertiary education duration was reduced from 17 years to 12 years. Specifically, middle school duration was shortened from 4 years to 3 years whereas secondary school duration was shortened from 7 years to 3 years. The argument is that, given the general call to increase female education as a critical policy instrument, could the reduction be detrimental to child health outcomes? Much as maternal education can serve as an instrument to improve child health outcomes, certain exogenous events such as climatic shocks can affect children even before they are born. As such, early life access to nutrition has long-run effects on health and well-being. When exposed to shocks during early life, it affects the fetal programming and consequently lead to undesirable outcomes during adulthood. Thus, the second chapter of the thesis is focused on testing whether extreme heat waves in utero and during early childhood causally affect child health outcomes. The conclusions emanating from the analyses of the two papers are as follows: in the first chapter, I find that focusing on women with equivalent educational attainment/qualification for which the educational reform ultimately affected school cycles' duration, there was a sharp decline in the years of schooling for the affected women. Despite the discontinuous change in schooling induced by the policy, I find that maternal years of schooling (whether basic or secondary) have no effect on fertility and children's low birth weight, and long- and short-term malnutrition. However, there appears to be some evidence of a positive effect in terms of reducing the probability of child mortality for women with basic education. In the second paper, we find negative effects of heat shocks experienced in utero on children's birth and early child health outcomes and potential mitigation strategies in SSA.