The Impact of Community-Based Health Services on Poverty and Low Parental Educational Attainment Induced Childhood Mortality in a Rural Sahelian District of Northern Ghana

Ayaga A. Bawah, INDEPTH Network
James F. Phillips, Columbia University
Martin Adjuik, Navrongo Health Research Centre
Maya N Vaughan-Smith, Population Council

Research in Africa demonstrates that parental poverty and low educational attainment adversely affect child survival. In Ghana, national health policies seek to address this problem by making primary health care services accessible to impoverished rural communities. Investments and programs to extend community health services to poor districts represents the core health strategy of the National Poverty Reduction Program. However, there is no evidence that this strategy mitigates poverty-related mortality differentials. This paper estimates time conditional hazard models for 18,369 children over the period 1996-2003 born in northern Ghana to test the hypothesis that exposure to experimental conditions reduces excess mortality associated with low parental educational attainment and high relative poverty. Cells of the experiment define alternative approaches to providing health services to the poor. Findings show that the adverse effects of poverty and low educational attainment effects are substantially reduced in communities where nurses provided IMCI care.