Health care professionals and the determinants of fertility and child mortality in Sub-Saharan Africa: a five-country study

Ashira T. Menashe-Oren, Alexander Weinreb


A longstanding approach to both improving overall health and reducing health inequalities in sub-SaharanAfricahas been to increase the availability of health professionals. The question is: given constraints on training and retaining medical doctors or highly-skilled nurses, can the desired health outcomes that underlie demographic change inAfricabe equally achieved by personnel with lower skill levels? Merging individual-level data from nationally representative Demographic and Health Surveys and Service Provider Assessments collected in five sub-Saharan African countries, this article examines the relationship between six health related indicators - each a major determinant of either fertility or child mortality - and the presence of doctors, registered nurses, midwives and auxiliary nurses. The six health indicators are organized into three health dimensions: reproductive health; child vaccination; treatment of sick children. We consider discrete effects of each type of medical personnel, the substitutability of one type for another, and interactions between them. Results confirm that the relationship between medical personnel and health outcomes varies across skill level and health dimension. We also show that all tiers contribute to all health outcomes, alone or in combination with other tiers, though registered nurses may be the most cost-effective generalists.

Ashira T. MENASHE-OREN, PhD Student,Department of Sociology and Anthropology, The HebrewUniversity, MountScopus, Jerusalem91905, Israel. E-Mail:

Alexander WEINREB, Associate Professor, Population Research Center, University of Texas, 305 E. 23rd Street, CLA 2.214. Austin, TX 78712-1699, USA. E-mail:



Sub-Saharan Africa; health care professionals; vaccinations; contraceptive use

Full Text



ISSN: 2035-5556

Reg. Tribunale di Roma n. 3321/54