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THE EFFECT OF THE HEALTH CARE SUPPLY ENVIRONMENT ON CHILDREN’S NUTRITIONAL STATUS IN RURAL NEPAL
DAVID R. HOTCHKISS a1, NANCY B. MOCK a1andERIC E. SEIBER a1 a1 Tulane University Health Sciences Center, School of Public Health and Tropical Medicine, Department of International Health and Development, 1440 Canal Street, Suite 2200, New Orleans, LA, USA 70112
This article examines the effect of access to health infrastructure, personnel and services on children’s nutritional status in rural Nepal. Data for the study come from the 1996 Nepal Living Standards Survey, which includes individual- and household-level information on children’s nutritional status and its environmental and socioeconomic determinants, and community-level information on the availability of health care infrastructure, personnel and services. The study uses a structural modelling approach to assess the relative contributions of the health care supply environment on children’s anthropometric status via the pathway of maternal and child health (MCH) service use. The findings suggest that improvements in the availability of outreach clinics and the structural quality of the closest public facility would be expected to have statistically significant and large effects on the use of MCH services, and that increases in MCH service use would have a statistically significant impact on weight-for-age, but not weight-for-height or height-for-age. The overall impact of the heath care supply environment on nutritional status is assessed through a series of policy simulations.