Schooling, Child labour, and the Returns to Healthcare in Tanzania

East Africa

Tanzania

Social Protection

Health insurance

A Adhvaryu, A Nyshadham

2012

Adhvaryu, Achyuta R., and Anant Nyshadham. “Schooling, Child Labor, and the Returns to Healthcare in Tanzania.” The Journal of human resources 47.2 (2012): 364–396.
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Secondary data is available at: https://microdata.worldbank.org/index.php/catalog/2251.

2012

N. A.

1991-1994 (baseline and endline)

The purpose of the study is to document how accessing formal-sector healthcare speeds up recovery from acute illnesses and shifts the amount of time allocated to both school and work for children.

Children (7-19 years old) from the Kagera region of Tanzania. Kagera is mostly rural and primarily engaged in producing bananas and coffee in the north, and rain-fed annual crops (maize, sorghum, and cotton) in the south.

A two-stage randomized stratified sampling procedure was employed. In the first stage, census clusters (or communities) were stratified based on agro-climatic zone and mortality rates and then were randomly sampled. In the second stage, households within the clusters were stratified into “high-risk” and “low-risk” groups based on the illness and death of household members in the 12 months before enumeration and then were randomly sampled.

• School Attendance
• Child labour (hours of work, farm, and non-farm labour)

Instrumental Variables

Study design: The main difficulty in estimating the impact of healthcare on education and work outcomes is self-selection. Certain individuals—for example, those with more severe illnesses, higher preferences for health, or greater access to financial resources—are more likely to select better healthcare options. Thus, comparing outcomes across individuals who used different healthcare options will lead to a biased estimate of the impact of using better healthcare. Moreover, fixed effects estimators cannot adequately address this problem because they do not control for unobserved severity, which varies by illness episode (that is, within multiple observations of the same individual), and which other studies have shown is the most salient bias for acute shocks. To overcome these challenges, the authors use as an instrumental variable the exogenous variation in the cost of formal-sector care. A dummy variable for the presence of a formal-sector health facility in one’s community is interacted with the number of days of rainfall in the month of the individual’s sickness and excludes only this interaction from the second stage while controlling for the main effects of the facility “existence” and days of rainfall in the first and second stages of a two-stage instrumental variables estimator.
Sample: the sample consists of 816 households from 51 “clusters” (or communities) located in 49 villages covering all five districts of

Kagera was interviewed up to four times, from Fall 1991 to January 1994, at 6–7-month intervals. The randomized sampling frame was based on the 1988 Tanzanian Census.
Survey Instrument: KHDS is a socioeconomic survey following the model of previous World Bank Living Standards Measurement Surveys. The survey covers individual, household, and cluster-level data related to the economic livelihoods and health of individuals, and the characteristics of households and communities.

Accessing better healthcare decreases the length of illness and changes children’s allocation of time to school and work. Children attend school for more days per week—but not for more hours per day—as a result of accessing better healthcare. There are no significant effects on child labor, but the results suggest that time spent in physically strenuous activities such as farming and herding increases.

Child Labour

Households

Local

Accessing better healthcare changed children’s allocation of time to work in Tanzania. Although there are no significant effects on child labour, the results suggest that time spent in physically strenuous activities such as farming and herding increases.

Accessing better healthcare decreases the length of illness. Children attend school for more days per week—but not for more hours per day—as a result of accessing better healthcare.

N. A.