Sub-Saharan African Social and Health Policies and the Poor: Three Essays Examining Impacts of Public Programs on Maternal Health Utilization, Children's Health, and Household Composition

The poverty literature sheds much insight into the disproportionate disadvantages the poor face when compared to the non-poor. The poor are more likely to suffer from disease, lack access to basic health services which make death preventable, and face greater barriers to human capital investment which would allow them to break the intergenerational cycle of poverty. This research examines the potential of social and health programming to support poor and vulnerable populations in sub-Saharan Africa. In the first essay, a quasi-experimental comparison group design is used to examine the impacts of a Ghanaian community-focused heath quality improvement program on maternal health utilization. The program was found to be significantly associated with possession of health insurance, a finding that was robust even among women who lacked health decision-making autonomy. The second and third essays examine the impacts of one of sub-Saharan Africa’s largest and rapidly expanding anti-poverty initiatives, social cash transfer schemes. The focus of the second essay is to determine whether the Kenya Cash Transfer for Orphans and Vulnerable Children (CT-OVC) is associated with health improvements, measured through proxy variables for malaria and pneumonia, among children 0-7 and under-5 years of age. The program provided cash grants to ultra-poor families supporting orphans and vulnerable children. The evaluation strategy included a cluster randomized longitudinal design. Using a generalized linear latent and mixed model with clustering at the household and location level, significant reductions in malaria and pneumonia symptoms were found among children 0-7 years of age, although insignificant findings for under-5s. The third chapter examines impacts on household structure, as they reflect changes in welfare or basic household economic strategy. A difference-in-differences OLS model was used to find that the program was associated with a decrease in number of children ages 6-11 years of age and an influx of newcomers due to deaths of caretakers and/or family members of their original households. Altogether, the results indicate that these two social and health programs have made promising gains, although more could be done to bolster multidimensional welfare of their most vulnerable beneficiaries.Doctor of Philosoph