UC San Diego

This dissertation consists of three chapters on healthcare access and demand for healthcare in low-income countries.Chapter 1 studies the impact of expanding access to facility birth on early-life mortality and subsequent healthcare use in Malawi. Using an exogenous increase in travel costs to health facilities, I find that only high-risk pregnancies with access to high-quality care experience significant survival gains. The systematic mismatch between high-risk pregnancies and low-quality facilities at the last mile helps explain the limited mortality reductions from access expansion. Exposure to low-quality facilities also decreases future healthcare visits, suggesting that expanding access to poor service quality can backfire by discouraging engagement with formal care.In Chapter 2, we leverage the 5x increase in medical colleges in India between 1980 and 2020 to measure the impact of college openings in a district on access to care, take-up of care, and health outcomes. We find that one additional batch of graduating students is associated with a 4.4% increase in health facilities and a 6.7% increase in health workers in the district, concentrated almost entirely in the private sector in urban areas. The mechanism operates through students from the district enrolling in the local college and becoming doctors. This leads to an increase in healthcare access, but we do not detect improvements in morbidity or mortality. Our findings suggest that reforming public hiring to leverage location preferences of local graduates could expand the supply of doctors in the public sector too.In Chapter 3, I examine how mothers in Sub-Saharan Africa update their delivery choices in response to day-of-birth deaths observed in their village. Using Demographic and Health Survey data from 38 countries and exploiting within-village variation in preceding births, I find that mothers shift toward facility delivery after home-birth deaths, while their response to facility-birth deaths depends on the observable risk of the pregnancy that died: they shift away from facilities when a low-risk pregnancy dies there, and toward higher-level facilities when a high-risk pregnancy dies there. These patterns are consistent with mothers attributing locally observed deaths to facility quality or pregnancy risk depending on the observable circumstances.