When a Doctor Falls from the Sky: The Impact of Easing Doctor Supply Constraints on Mortality

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 e ect 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 nd 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 signi cant 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. ∗Department of Economics, Sociology and Statistics, RAND, 1200 South Hayes, Arlington, VA 22202. Email: eokeke@rand.org. This project would not have been possible without the help of many people. I am grateful to: the Director-General and State Directors of the NYSC program, the Commissioners of Health of Akwa Ibom, Bauchi, Gombe, Jigawa, and Kano states, and sta of the Primary Health Care Development Agency and State Ministries of Health. I also want to thank the following individuals: Nnenna Ihebuzor, Ibrahim Yisa, Christie Akwaowo, and Usman Bashir whose support was critical at various stages. I am grateful to Obinna Onwujekwe and the sta of the Health Policy Research Group, University of Nigeria who provided implementation support, and to Bamidele Aderibigbe, Saidu Abubakar, Sadia Aliyu, Sadiya Awala, Yakubu Suleiman, and Edidiong Umoh who oversaw the eld work. I am very grateful to all the data collectors and supervisors, and to all the study participants, who were exceedingly generous with their time. Last, but not least, I want to thank Isa Abubakar, who provided oversight of the study in Nigeria and whose support and assistance continue to be invaluable. This project bene ted from many helpful discussions with Peter Glick and A.V. Chari, who were involved during the early stages. Excellent research assistance was provided by Juliana Chen, Crystal Huang, Stephen Okpalaononuju, Adeyemi Okunogbe, and Victor Olajide. This study was funded by the Eunice Kennedy Shriver National Institute for Child Health and Human Development through Grant No: R01HD083444. The funder played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.