University of the Thai Chamber of Commerce Library

Essays on child health outcome inequalities in Nepal / Purna Bahadur Khand.

By: Khand, Purna Bahadur [author]Contributor(s): Lalita Chanwongpaisarn Nguitragool [advisor] [advisor] | University of the Thai Chamber of Commerce. Philosophy in EconomicsMaterial type: TextTextPublisher: 2018Description: 136 pagesContent type: text | text Media type: unmediated | computer Carrier type: volume | online resourceSubject(s): Child care services -- Nepal | Medical care -- NepalDDC classification: 362.1095496 Online resources: เอกสารฉบับเต็ม (Fulltext) Dissertation note: Dissertation (Ph.D. (Economics)) -- University of the Thai Chamber of Commerce, 2018. Abstract: Nepal has made appreciable progress in improving overall health outcomes of people during the last few decades. But, how such achievement is distributed across the various socioeconomic and demographic strata is equally important. Large inequalities between the poor and the rich in the health sector become prime concern in both developing and developed countries as growing inequalities have more adverse impact on vulnerable and impoverished societies in one hand and reduces their contribution for socioeconomic development on the other hand. Nepal is no exception at this matter. The extent and the root cause of the health outcome inequalities are the crucial information for making systematic policy at reducing the inequality. The aims of this study are to estimate estimating the child health outcome inequality in Nepal year 1991–1995 and year 2010–2015 and to decompose the inequality into its covariate to identify important contributors. This study also analyzes how change in the child health outcome inequality is attributed by the changes in the contributing factors over time. The major health sector interventions by the Nepal government with few examples of achievements and their distributions in the form of child health outcomes in the last few decades are briefed in the first chapter. The second chapter overviewed the health care system of Nepal. The third chapter focuses to estimate neonatal death inequality and explore major contributors to the inequality using data from all five waves of Nepal Demographic and Health Survey (NDHS) for the periods 1991–1995, 1996–2000, 2001–2005, 2006–2010 and 2011–2015 respectively conducted in 1996, 2001, 2006, 2011 and 2016. I used a concentration index (CI) to measure the inequality in neonatal deaths and decomposed the index to identify which and how determinants contribute to the inequality applying the methods proposed by Kakwani et al. (1997) and Wagstaff et al. (2003). I took the household's wealth index as a ranking socioeconomic status variable. The measurement of neonatal deaths inequality found that there were substantial newborn deaths inequalities between the poor and the better off in Nepal which were more concentrated in disadvantaged population. I also used Gini coefficient, SII and RII to measure the inequalities and found consistent with the CI. Further, the neonatal deaths inequality has increased from the third survey period and become the worst in the last survey. The decomposition of the neonatal deaths inequality found that mother's education was the highest contributors to the inequality followed by higher birth order, hill zone, rural residence and small sized child during birth. This calls for effective mother's education program targeted households to reduce the inequality soon. The similar calculation is performed to a sub-sample analysis in the latest survey by excluding two provinces where most of the tertiary level health care facilities of the country are concentrated and the decomposition result was consistent with the whole sample. The fourth chapter explains how change in the neonatal deaths inequality is attributed by changes in the contributions of the determinants. This study took the change in the neonatal deaths inequality between the periods 2006–2010 and 2011–2015 which was most recent as well as the highest among the changes during the last 25 years in Nepal. I used both Oaxaca decomposition and total differential approach to decompose the change in the inequality between the periods. Both methods showed that the largest share of the change in the inequality was attributed by the change in contribution of mother's education. Both, decomposition of the inequality and decomposition of its change found mother higher education is very crucial. It suggests the policy priority to educate poor mother and its continuation. However, for remaining major contributors to the change in the inequality, the two different methods prioritized differently. Comparing two methods, total differential approach is more informative than Oaxaca decomposition. The final chapter concludes and discusses the whole study and its limitations.Measuring of the newborn deaths inequality as well as decomposing the inequality both at level and change yielded useful information regarding relative importance of various determinants of the inequality. It could be helpful to the policy formulation to prioritize the mother and the child health programs for systematic reduction of child health outcome inequality in Nepal.
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Dissertation (Ph.D. (Economics)) -- University of the Thai Chamber of Commerce, 2018.

Nepal has made appreciable progress in improving overall health outcomes of people during the last few decades. But, how such achievement is distributed across the various socioeconomic and demographic strata is equally important. Large inequalities between the poor and the rich in the health sector become prime concern in both developing and developed countries as growing inequalities have more adverse impact on vulnerable and impoverished societies in one hand and reduces their contribution for socioeconomic development on the other hand. Nepal is no exception at this matter. The extent and the root cause of the health outcome inequalities are the crucial information for making systematic policy at reducing the inequality. The aims of this study are to
estimate estimating the child health outcome inequality in Nepal year 1991–1995 and year 2010–2015 and to decompose the inequality into its covariate to identify important
contributors. This study also analyzes how change in the child health outcome inequality is attributed by the changes in the contributing factors over time.
The major health sector interventions by the Nepal government with few examples of achievements and their distributions in the form of child health outcomes in the last few decades are briefed in the first chapter. The second chapter overviewed the
health care system of Nepal. The third chapter focuses to estimate neonatal death inequality and explore major contributors to the inequality using data from all five waves
of Nepal Demographic and Health Survey (NDHS) for the periods 1991–1995, 1996–2000, 2001–2005, 2006–2010 and 2011–2015 respectively conducted in 1996, 2001,
2006, 2011 and 2016. I used a concentration index (CI) to measure the inequality in neonatal deaths and decomposed the index to identify which and how determinants contribute to the inequality applying the methods proposed by Kakwani et al. (1997) and Wagstaff et al. (2003). I took the household's wealth index as a ranking socioeconomic status variable. The measurement of neonatal deaths inequality found that there were substantial newborn deaths inequalities between the poor and the better off in Nepal which were more concentrated in disadvantaged population. I also used Gini coefficient,
SII and RII to measure the inequalities and found consistent with the CI. Further, the neonatal deaths inequality has increased from the third survey period and become the
worst in the last survey. The decomposition of the neonatal deaths inequality found that mother's education was the highest contributors to the inequality followed by higher birth
order, hill zone, rural residence and small sized child during birth. This calls for effective mother's education program targeted households to reduce the inequality soon. The similar calculation is performed to a sub-sample analysis in the latest survey by excluding two provinces where most of the tertiary level health care facilities of the country are concentrated and the decomposition result was consistent with the whole sample.
The fourth chapter explains how change in the neonatal deaths inequality is attributed by changes in the contributions of the determinants. This study took the change in the neonatal deaths inequality between the periods 2006–2010 and 2011–2015 which was most recent as well as the highest among the changes during the last 25 years in Nepal. I used both Oaxaca decomposition and total differential approach to decompose
the change in the inequality between the periods. Both methods showed that the largest share of the change in the inequality was attributed by the change in contribution of
mother's education. Both, decomposition of the inequality and decomposition of its change found mother higher education is very crucial. It suggests the policy priority to educate poor mother and its continuation. However, for remaining major contributors to the change in the inequality, the two different methods prioritized differently. Comparing two methods, total differential approach is more informative than Oaxaca decomposition.
The final chapter concludes and discusses the whole study and its limitations.Measuring of the newborn deaths inequality as well as decomposing the inequality both at level and change yielded useful information regarding relative importance of various determinants of the inequality. It could be helpful to the policy formulation to prioritize
the mother and the child health programs for systematic reduction of child health outcome inequality in Nepal.

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