Does proximity to health facilities improve child survival? New evidence from a longitudinal study in rural Tanzania

Distance to health facilities is often cited as a major barrier limiting access to care in sub-Saharan and other developing countries. There are however limited data on the causal effects of distance to facilities on child survival. This paper uses unique longitudinal data collected in a rural district of Tanzania to test whether enhanced proximity to health services arising from investment in dispensaries contributed to the rapid decline in under-five mortality recently observed in Tanzania. Data on births, deaths, migrations, SES and geographic data on households and facilities have been recorded every 120 days since 1999 (n≈85,000). We use multivariate analysis to measure the causal effects of distance to health facilities on child survival and to test interactions between distance to health facilities and maternal education and households’ SES. Initial results indicate that, from 2000 to 2010, child mortality declined close to 40% (from 115 to 70 per 1000). The distance to the closest health facility remained a strong determinant of child survival, even after adjusting for endogeneity biases. The development of community-based primary health care can improve health outcomes and can increase equity by offsetting the detrimental effects of low maternal education, household poverty and distance to health facilities.