Title

Poverty, institutions and child health in post-communist rural Romania: A view from below

Date of Award

5-2006

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Administration

Advisor(s)

Timothy Smeeding

Keywords

Poverty, Institutions, Child health, Romania, Postcommunist, Rural health

Subject Categories

Eastern European Studies | Health Policy | Public Administration | Rural Sociology | Social Welfare

Abstract

Romania's high rates of child and infant mortality along with high rates of various infectious diseases, such as tuberculosis and AIDS, cannot be explained by the mainstream theories on child health and survival, which posit that maternal education and immunization rates are the main determinants in influencing child health outcomes. In Romania, female adult literacy rate is 96,3 percent (2003, UNDP) and 98 percent of all children are immunized (World Bank Report, 2001). The alarming child health outcomes that Romania displays at present, the increase in poverty for large portions of the population (especially rural families with many children) and the decreasing provision of primary health services (in the rural areas in particular) and affordable medicine are the issues which motivate this research. In this study I examine the barriers experienced by the rural poor when they access health care for their children. I focus particularly on the institutional arrangements that have been inherited from the communist regime and show how formal and informal norms may adversely affect child health outcomes. Based on an extensive field research in Romania over the last 4 years, I examine the mechanisms through which factors such as household poverty, education, income, food consumption and nutrition, and access to health care services may affect child health and survival. My findings suggest that formal, and particularly informal norms imbedded in the Romanian health care system play a critical role in influencing the decisions poor households make with regard to their children's health. This research suggests that greater efforts to redistribute health care resources and to reduce fraud and informal payments are required if modern maternal and child health care services are to reach the poor in rural areas. The policy solution I propose is to scale back the traditional national governance structures and complement these with community-based, multi-sectoral approaches to delivering child health services.

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