Using panel data from Indonesia, this paper analyzes the linkages between child nutrition, health care, household wealth and parental education in order to detect transmission channels between health, education, nutrition, water and sanitation access, five critical MDG targets. This paper therefore also aims at providing an empirical analysis of the drivers of complementarities between these goals at the micro level micro-level perspective. We find that maternal education has a positive and long term effect on child health and that this effect is partly reflected in reproductive behavior and partly conveyed to child health outcomes through child caring practices such as breastfeeding. Although we cannot rule out the existence of strong complementarities existing between household wealth or income and child health, the effect of positive changes in this variable appears to be present only in the short term. On the other hand, there are supply-side factors such as lack of sanitation and access to health facilities which also strongly affect children in terms of anthropometric outcomes.
Little is known about public health-care supply in Eastern Indonesia, a region that shows worse health outcomes than the rest of the country. Drawing on a new dataset (IFLS East 2012), this paper examines the availability and quality of public health-care facilities (puskesmas and posyandu) in Eastern Indonesia. Our findings suggest that public health-care supply plays a larger and more important role in Eastern Indonesia compared with Western Indonesia. However, this stronger reliance and dependence on public health-care provision has not necessarily resulted in quality health-care supply. Although significant improvements have been achieved over time, we found that many puskesmas and posyandu could benefit from more and better-trained staff (education, training, availability, absenteeism) and better physical endowment (infrastructure, medical equipment, and medications). The results further suggest that remarkable differences in the provision of health care exist between urban and rural areas; urban areas have on average better-equipped puskesmas, whereas rural areas seem to have better-equipped posyandu. Furthermore, we found that direct funds from the central level (central government funds and Jamkesmas), despite the decentralization process, play a major role in financing the operations of public health facilities. In rural Eastern Indonesia, these central-level funds constitute about 80 percent of the total operational budget of a puskesmas. 1 Jan Priebe (jan.priebe@tnp2k.go.id or jpriebe@uni-goettingen.de) is a senior economist at TNP2K’s Cluster 1 team. Fiona Howell is the social assistance policy advisor in TNP2K, Government of Indonesia. Maria Carmela Lo Bue is research associate at the Development Economics Research Group at the University of Gottingen, Germany. The authors would like to thank Suahasil Nazara, Elan Satriawan, and Sudarno Sumarto for valuable input and comments. Special thanks go to SurveyMETER, in particular, to Bondan Sikoki, Ni Wayan Suriastini, and Firman Witoelar for providing clarifications on the IFLS East 2012 data. We also wish to gratefully acknowledge Maciej Czos and Pamela S. Cubberly for their editorial assistance. Any remaining errors are solely our responsibility.
