Public health spending and infant and child mortality in India: a state-year panel analysis

Background: To investigate the association between public health spending and probability of infant and child death in India. Methods: We used data from the three rounds of National Family Health Survey (NFHS) conducted in India during 1992-93, 1998-99 and 2005-06 to investigate the association between public health spending and probability of infant and child death. We used data from the birth history of three NFHS rounds to create state-year panels of births, infant and child deaths, state-level public finance variables, food grain production, household and individual variables for the period 1980-2005. Two-stage probit regression model is used to investigate the association. State-level per capita gross fiscal deficit is used as an instrument for estimating two-stage probit model. Findings: Findings suggest association between public health spending and infant and child mortality in India. A 10% increase in per capita public health spending is likely to reduce the probability of infant and child deaths by 0•005 (95% CI: 0•003, 0•007) and 0•003 (95% CI: 0•002, 0•004) respectively. The second and third lags of public health spending were also statistically significant. Other factors affecting infant and child death were sex of the child, birth order, mother’s age at birth of the index child, mother’s schooling and urban-rural residence. Interpretation: Public health spending was associated with probability of infant and child death in India. Our findings lend support to the government’s initiative to increase public health spending in India.