Association for Public Policy Analysis & Management

Do investments in public health by the government crowd-in or crowd-out private household efforts for better health? This has important social policy implications particularly for the poor. We study how slum resident household vary their private efforts in controlling  diseases borne by flies and mosquitoes, when their slums receive vector-control programs from the municipality. We also investigate the joint impact of these alternative prevention efforts affect health status (i.e. the incidence of diseases such asmalaria, stomach disorders, etc.). For this analysis we use data on slum resident households from a nationally representative data from the 2012 wave of the National Sample Survey (NSS) on Housing Conditions collected by the Government of India. A key econometric concern in this analysis relates to model specification on two aspects; first the outcome model may not be correctly specified and secondly, there are concerns in comparing slums which had access to public health efforts with respect to those who did not. We use a regression and weighting strategy, i.e. a doubly robust estimation strategy to guard against different specification problems to look at the relationship between public and private vector-control efforts on health outcomes.  We look at environmental health diseases e.g. stomach disorders, malaria, skin diseases and fever and evaluate the effectiveness of the household-level avoidance measures and a public-vector control program in interacting with or countering the effects of the ambient environmental quality on the household's health outcomes.  The preliminary results show that while private avoidances e.g. treating water by physical or chemical methods, storing water in safe containers and daily removing garbage from the household are not effective in averting morbidity due to these environmental health diseases, an exposure to a public vector initiative in controlling the problem of flies and mosquitoes is found to be substantially drop the incidence of such diseases.  We further wish to explore how the exposure to a public program influences the household’s initiatives to take up avoidance measures.  Given a growing emphasis on public health and sanitation in developing countries context, this paper calls for more policy focus on public investments in public health and sanitation  programs especially for the growing urban slum population such as this program which tries to control the problems of flies and mosquitoes at the slum settlement level. The finding that private efforts are substantially ineffective when compared to the public programs due to the high externality effects of neighborhood sanitation conditions necessitates more targeted public sanitation programs for slums in the rapidly urbanizing developing countries.