Social Sector Expenditure and Child Mortality in India: A State-Level Analysis from 1997 to 2009

Abstract

BackgroundIndia is unlikely to meet the Millennium Development Goal for child mortality. As public policy impacts child mortality, we assessed the association of social sector expenditure with child mortality in India.Methods and FindingsMixed-effects regression models were used to assess the relationship of state-level overall social sector expenditure and its major components (health, health-related, education, and other) with mortality by sex among infants and children aged 1–4 years from 1997 to 2009, adjusting for potential confounders. Counterfactual models were constructed to estimate deaths averted due to overall social sector increases since 1997. Increases in per capita overall social sector expenditure were slightly higher in less developed than in more developed states from 1997 to 2009 (2.4-fold versus 2-fold), but the level of expenditure remained 36% lower in the former in 2009. Increase in public expenditure on health was not significantly associated with mortality reduction in infants or at ages 1–4 years, but a 10% increase in health-related public expenditure was associated with a 3.6% mortality reduction (95% confidence interval 0.2–6.9%) in 1–4 years old boys. A 10% increase in overall social sector expenditure was associated with a mortality reduction in both boys (6.8%, 3.5–10.0%) and girls (4.1%, 0.8–7.5%) aged 1–4 years. We estimated 119,807 (95% uncertainty interval 53,409 – 214,662) averted deaths in boys aged 1–4 years and 94,037 (14,725 – 206,684) in girls in India in 2009 that could be attributed to increases in overall social sector expenditure since 1997.ConclusionsFurther reduction in child mortality in India would be facilitated if policymakers give high priority to the social sector as a whole for resource allocation in the country’s 5-year plan for 2012–2017, as public expenditure on health alone has not had major impact on reducing child mortality.

Public Health Spending and Infant and Child Mortality in India: A State-Year Panel Analysis

“…None of the earlier Indian studies have treated public health spending as an endogenous variable. [16][17][18] The limitations of our study must also be noted. An obvious limitation of our study is that we could not control for household wealth in the regression analysis.…”

“…These studies have led to mixed findings. While Makela et al (2013) found negative association between social sector spending and child mortality, 18 Deolalikar (2005) found a weak relationship. 16 Bhalotra (2007) found the negative association between public health spending and infant mortality only in rural areas.…”

“…Taking cognizance of the vital role that public health spending can play in improving child survival, a few studies have empirically examined the association between public health spending and infant and child mortality. [15][16][17][18][19][20] The findings of these studies are mixed.…”

“…16 The study by Bhalotra (2007) might have got affected by the small sample sizes in certain states like Kerala, Assam, Punjab, Tamil Nadu, Haryana and West Bengal. 17 Makela et al (2013) examined the association between social sector expenditure and child mortality. Social sector expenditure, among others, also included expenditure on education.…”

“…Social sector expenditure, among others, also included expenditure on education. 18 Given the lack of systematic and robust evidence, our study investigates the association between public health spending and infant and child mortality in India using the three rounds of National…”