Poverty, Health Infrastructure and the Nutrition of Peruvian Children

After the Peruvian economic crisis of the late 1980s, the 1990s witnessed a significant pro-poor expansion of the country`s health infrastructure that was instrumental in increasing preventive and primary health care expenditures. Using empirical evidence, this paper discusses the effect of this expansion in health infrastructure on child nutrition in Peru, as measured by the height-for-age z-score. Using a pooled sample from the 1992, 1996 and 2000 rounds of the Peruvian DHS, this analysis controls for biases in the allocation of public investments by using a district fixed effects model. The econometric analysis finds a positive albeit small effect of the expansion of the last decade. After desegregating by type of location, however, the effect was found to be significant only in urban areas. Furthermore, the effect is highly nonlinear and has a pro-poor bias. The estimated coefficient for health infrastructure in less endowed districts is 10 times higher than that in the better-endowed districts. The pro-poor bias refers to the fact that the estimated effect is larger for children of less educated mothers. In this sense, this policy seems to have had a pro-poor bias within urban areas, while at the same time excluding the rural population, a traditionally marginalized population group in Peru. These findings support the idea that reducing distance and waiting time barriers may be necessary, but that more explicitly inclusive policies are required to improve the health of the rural poor, especially indigenous groups, so that they can escape this kind of poverty trap.