Effect of reliable electricity on health facilities, health information, and child and maternal health services utilization: evidence from rural Gujarat, India|
Chen, Yvonne Jie; Chindarkar, Namrata & Xiao, Yun
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.
Electrification; Infrastructure; Health systems; Health facilities; Health information; Health services utilization; Difference-in-differences; India