Effect of reliable electricity on health facilities, health information, and child and maternal health services utilization: evidence from rural Gujarat, India

Abstract

Background: Reliable basic infrastructure, particularly electricity, is a critical enabling factor in improving health systems and consequently achieving the health sustainable development goals (SDGs). Yet, there is no systematic and rigorous study examining the effect of reliable electricity on health systems in a developing country context. In this study, we examine the effect of Jyotigram Yojana (JGY), a rural electrification program providing 24-h electricity to rural non-agricultural users in Gujarat, India, on core components of health systems including health facilities, health information, and health services utilization.

Methods: We match data from the District Level Household and Facility Survey (DLHS-II and DLHS-III) and administrative data from electricity distribution companies on JGY implementation. Matching survey data with administrative data allows us to precisely identify the relevant sample from Gujarat for our data analysis. We then apply a difference-in-differences framework to address potential bias in JGY implementation by comparing the sample from Gujarat (treatment group) with that from Maharashtra (control group). Our key independent variable is a dummy indicating JGY implementation, which operationalizes access to reliable electricity. It takes value 1 if the PHC/eligible woman/child is located or residing in the state of Gujarat and 0 if located or residing in the state of Maharashtra. Our outcome variables cover three core components of health systems-health facilities, health information, and child and maternal health services utilization. Each outcome is a binary variable. We therefore estimate probit models with appropriate control variables.

Results: We find that JGY implementation significantly improved the operational capacity of health facilities, in particular primary health centers (PHCs), by increasing the availability and functionality of a wide range of essential devices and equipment. JGY also significantly increased access to health information through television. Further, JGY increased utilization of health services; in particular, it increased the probability of children receiving critical vaccinations and pregnant women receiving antenatal care. Our results are robust to alternate specifications and analysis using alternate data.

Conclusion: Reliable electricity can be an effective tool in improving core components of health systems. In addition to targeting direct factors within the health systems such as health workforce and health financing, investments in supporting infrastructure are warranted to achieve the health SDGs.

Keywords: Difference-in-differences; Electrification; Health facilities; Health information; Health services utilization; Health systems; India; Infrastructure.

Fig. 1

Pre-JGY trends of child immunization and maternal health outcomes using DLHS-II data. a Pre-JGY trend of child immunization outcomes. b Pre-JGY trend of maternal health outcomes. X-axis shows each year of birth/delivery from 1999 to 2003, that is period corresponding to pre-JGY implementation. Y-axis plots cohort mean corresponding to each year. GJ, Gujarat; MH, Maharashtra; DPT, received first dose of DPT; DPT3, received all three doses of DPT; Polio, received first dose of polio; Polio3, received all three doses of polio; receivedANC, received at least one ANC check-up; threeANC, received at least three ANC check-ups; firstANC_t1, received ANC check-up in the first trimester; deliveryHF, delivered in a health facility; deliveryPub, delivered in a public health facility; deliveryPri, delivered in a private health facility