Hospital Births, Adverse Selection and Infant Mortality

Edward Okeke, RAND Corporation
Amalavoyal Chari, RAND Corporation

Despite policies promoting births in health facilities in developing countries, little is known about the effect this has on maternal and child mortality. To estimate these returns, we exploit a policy experiment in Rwanda where the government instituted a pay-for-performance program that incentivized health facilities for hospital deliveries. Phase 1 of the program was implemented in 12 randomly chosen districts in 2006 and expanded to 7 more districts in 2008. Using Demographic and Health Surveys data on births in Rwanda we first show that the P4P program raised rates of hospital births in treated districts. We then exploit this exogenous shock to hospital births to identify the causal effect of a hospital birth on mortality. We find a statistically significant effect of being born in a health facility on an infant's risk of dying within the first month of birth.