Can Expanding Access to Basic Health Care Improve Children’s Health Status? Lessons From Indonesia’s ‘Midwife in the Village’ Program

Published 2005
Authors
Elizabeth Frankenberg, University of California, Los Angeles
Wayan Suriastini, SurveyMeter, and University of Gadjah Mada Duncan Thomas, University of California, Los Angeles

Abstract
In the 1990s, the Indonesian government placed over 50,000 midwives in communities throughout the country. We examine how this expansion in health services affected children's height-for-age. To address the problem that midwives were not randomly allocated to communities, the estimation exploits the biology of childhood growth, the timing of the introduction of midwives to communities, and rich longitudinal data. The evidence indicates that the nutritional status of children fully exposed to a midwife during early childhood is significantly better than that of their peers of the same age and cohort in communities without a midwife. The former are also better off than children assessed at the same age from the same communities but who were born before the midwife arrived. Within communities, the improvement in nutritional status across cohorts is greater where midwives were introduced than where they were not. This result is robust to the inclusion of community fixed effects.