When a Doctor Falls from the Sky

The Impact of Easing Doctor Supply Constraints on Mortality

by Edward N. Okeke

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To what extent are bad health outcomes a result of bad providers? This paper describes the results of a unique policy experiment designed to answer this provocative question. In this experiment, which was conducted in coordination with the Nigerian government, some communities were randomly selected to receive a new doctor. These doctors were posted to the public health center serving the community to work for a year. Prior to their arrival, health care was provided by mid-level health care workers. To separate the effect of (ostensibly higher) quality from that of quantity, another group of communities was provided with an additional mid-level health care worker. A third group of communities received no additional workers. No other inputs were provided. I find that, over the duration of the posting, newborn infant mortality dropped by more than 20 percent in communities assigned a new doctor. These mortality gains can be traced to significant improvements in the quality of medical advice and treatment. I estimate that a scaled-up version of the program would conservatively return about $5 for every dollar spent.

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