The effectiveness and cost of health delivery systems in Cote d'Ivoire, Nigeria, and Tanzania: Private versus public allocation, quality of service provision, and management structure

The three analyses that constitute this dissertation study the relationship between health facility operational practices, facility characteristics, and measures of service utilization, cost, and health.;Chapter II. The Effect of Structural Characteristics on Family Planning Program Performance in Cote d'Ivoire and Nigeria. The country data captures both supply and demand characteristics, which allowed us to measure structural effects net of demographic controls. The dependent variables were facility level service cost and contraceptive output, and total output had an endogenous influence on contraceptive cost. Both size and specialization matter. In both countries, vertical (stand alone) Family Planning facilities provide significantly more contraception than their integrated service counterparts. Larger facilities offer lower average cost contraception, especially in Nigeria. Finally, facility management has discretion over many model "control" variables, even to the point of facility location. When comparing operating authorities, it is essential to consider everything that is potentially under managerial control.;Chapter III. Operating Authority and Quality in Family Planning Service Provision and Cost in Tanzania. This chapter applies the same chapter II theory and analysis to the richer Tanzania data. Unlike chapter II, Tanzania does not have a robust private sector or massive involvement of the International Planned Parenthood Federation. Most of the demographic controls were insignificant, as was the effect of quality. Strong evidence of economies of scale in production is present; and, unlike the chapter II analysis, the major NGO alternatives provided contraception at a much higher cost per unit than government facilities.;Chapter IV. Antenatal Health Care Quality: Does it Matter? Evidence from Tanzania. Facility quality contributes to both service utilization and healthy birth weights among the local population in this health production function model. The estimation procedure corrects for data clustering, the endogeneity of service utilization, and birth measurement sample selection. Although quality is a strong determinant of the prenatal care use, that use has little to no impact on the subsequent birth weight. Birth weight is a very inaccurate measure in Tanzania. Subjective birth size performed much closer to expectations, but is not a discriminating enough measure to capture small prenatal care health effects.