Social Capital and Access to Primary Health Care in Developing Countries: Evidence from Sub-Saharan Africa
Posted: 11 Feb 2015 Last revised: 24 May 2017
Date Written: September 9, 2015
The ability of communities to engage in collective action (e.g. by maintaining health facilities) and promote the relevant social norms (e.g. introducing sound hygiene practices) would appear to be crucial for health improvements in developing countries. This ability is often referred to as social capital. Intuition suggests that communities endowed with more social capital should be better able to provide local health services, all else being equal, suggesting a causal relation between social capital and health. We thus here test for a causal role of social capital, as measured by self-reported trust, in determining access to basic health facilities in sub-Saharan Africa. To skirt the reverse-causality problems between social capital and basic health, we rely on instrumental-variable (IV) estimates. Using Afrobarometer data, we find that a one standard-deviation increase in trust is predicted to lead to a 0.22 standard-deviation fall in doctor absenteeism, a 0.31 standard-deviation fall in waiting time and a 0.30 standard-deviation fall in bribes. As a robustness check, we also use a different database (DHS) regarding a different health issue, access to clean water. We find that a one standard-deviation rise in trust leads to a 0.33 standard-deviation rise in access to clean water. We find a large causal impact of social capital on the provision of health related local public goods. The variety of public goods considered provides insights about the possible channels through which social capital is converted into health improvements.
Keywords: Social Capital, Health, Africa, Causality
JEL Classification: I1, D7, H4
Suggested Citation: Suggested Citation