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Abstract
Despite rapid economic growth in recent years, Mozambique remains a very poor
country. Expenditure-based poverty measures are reflected in widespread food insecurity
and poor health status. In recognition of these problems, the Government of Mozambique
is promoting expanded and improved quality and equity in access to health care as an
important component in the global strategy to fight poverty. Given years of colonial
neglect and systematic destruction of health facilities during the civil war, recent
government policy has focused on expanding the rural health network. However, insofar
as the ultimate objective of the provision of curative services is to ensure that those in
need of care receive effective treatment, it is also necessary to think beyond supply.
Specifically, we need to consider how individuals behave during episodes of illness, and
what factors affect this behavior. This paper provides quantitative evidence on the
importance of individual, household, and community characteristics on individuals’ care-seeking
decisions during episodes of illness. The paper estimates a “flexible” multinomial
model of health care provider choice conditional on illness using data from the 1996/97
Mozambique National Household Survey on Living Conditions (IAF). The empirical
analysis is underpinned by a basic theoretical framework of utility maximization and
household production of health. A number of individual and household characteristics,
e.g., age, education, and reported symptoms, stand out as highly significant determinants
of health seeking behavior. Also, prices, defined in the model as the composite of user
fees and time costs associated with consultations at different providers, are found to be important determinants of choice. The results indicate that the eradication of poverty,
independent of improvements in physical access to health care and education, will have
only a negligible effect on health care choices.