Convergence in Child health care utilisation and Outcomes
7.3.5. Conditional β -convergence in child health status
Although, the absolute convergence model presented the evidential support for unconditional convergence, it is not reasonable to assume that all the states do share same socioeconomic conditions. Therefore, to account for socioeconomic variability of the states, conditional β-convergence was estimated by including two more explanatory variables: proportion of illiterate population and proportion of population in poor wealth quintile in the regression model. The absolute β-convergence estimates, the conditional β
174 estimates for children full immunisation rates also showed negative β coefficients (β= -.15848, p<0.000, R2 = 0.68) in the entire period, 1992-2006, thereby, supporting the convergence hypothesis. However, the piecewise conditional β-convergence model estimates for child full immunisation coverage showed greater volume, speed of convergence and goodness of fit (β= -.18017, p<0.001, R2 = 0.58) during 1992-1998 than (β= -.15952, p<0.000, R2 = 0.70) 1998-2005 (Table 7.3a). The conditional β-convergence results for children underweight during 1992-2006 indicated a convergence, but the adjusted R2 indicated the poor goodness of fit for the model. Nevertheless, the conditional β estimates for children underweight showed the greater volume and speed of convergence (β= -.15835, p<0.026, S= 17% per annum) for the recent period than (β= -.06652, p<0.282, S= 06% per annum) previous period (Table 7.3b). The conditional β-convergence estimates for NNMR indicated that β-values for all three periods were negative, thereby, indicating convergence in NNMR over time. Similar to absolute β-convergence estimates of NNMR, conditional β-convergence estimates also suggests that the volume of convergence (β=.-28982, p<0.000) was higher during 1992-1998 than (β= -.12649, p<0.023) 1998-2006. Moreover, the estimates of the speed of convergence and goodness of fit measured by the adjusted R2 also indicated the similar pattern (Table 7.3c).
However, a comparison of absolute and conditional β-convergence estimates showed that after controlling for the state level proportion of illiterate population and poverty ratios, the volume and speed of convergence indicated a greater conditional β-convergence than unconditional β-convergence. Moreover, comparison of pattern of convergence during 1992-2006 for different child health indicators revealed that child full immunisation showed a greater volume of convergence in comparison to other two indicators. However, piecewise regression estimates showed greater convergence in the recent period (1998-2006) for child full immunisation compared to the greater volume of convergence was during 1992-1998 for NNMR and underweight.
175 Table 7.3a. Conditional 𝛽-convergence for full immunisation of children in age 12-23 across the major states, India, 1992-2006
Note: 1. States: n=24, df 23; 2. () P value
Table 7.3b. Conditional 𝛽-convergence for children underweight across the major states, India, 1992-2006
176 7.3.6. Sigma convergence in averages of child health status
In the early part of this study, we noted Quah (1996) and Young et al. (2008) observations that β-convergence is necessary but not a sufficient condition for Sigma convergence. In other words, a country experiencing β-convergence may not be experiencing a sigma convergence. Therefore, it is necessary to test for sigma convergence alongside the β convergence. Figure 7.4 shows the results for Sigma convergence in averages of child health status. The sigma convergence results for child health indicators showed a mixed pattern: three out of two indicators indicated a convergence trend in child health status.
The trends in standard deviation in children full immunisation showed evidence for divergence until 1998-99, but convergence thereafter. However, children underweight indicated a divergent trend that the dispersion in the percentage of underweight children gradually increased in recent periods (1992-93) compared to earlier periods (1998-99 and 2005-06). Results in case of NNMR also indicated a convergent trend over the period, the dispersion in NNMR declined from 16.2/1000 in 1981 to 10.4/1000 live births in 2009.
Figure 7.4. Sigma convergence in averages of child health indicators across the major states, India; 1981-2009
10.06 10.13 10.35
21.04
26.56
17.99
0.00 5.00 10.00 15.00 20.00 25.00 30.00
1992-93 1998-99 2005-06
Standard deviation
Period
Children Underweight Children Full Immunization
177 7.3.7. Convergence in absolute and relative health inequalities
To overcome the drawback of traditional convergence measures, this section assesses the convergence in inequalities in child health indicators such as children full immunisation, underweight and NNMR across the states. This section measured two types of inequality convergence: first, convergence in overall health inequalities and second, convergence in socioeconomic inequalities in child health indicators. As, this study pointed out earlier that, the overall health inequalities are classified into absolute inequalities measured in terms of AID and DMM and the relative inequalities measured in terms of Gini coefficient.
Thus, convergence in absolute and relative health inequalities was measured based on a percentage reduction in DMM and Gini: a positive change in the percentage points indicate convergence and a negative value implies divergence. However, the convergence in socioeconomic inequality in child health was estimated using the sigma convergence measure in CI values of the states.
Figure 7.5a shows the trends of percentage of absolute convergence in children full immunisation, children underweight and NNMR among the major Indian states, 1981-2009. The results in case of children full immunisation revealed that the absolute inequalities indicate for divergence with an increase in inequalities by 34% during 1992-99, but later divergence was replaced with convergence with a decline in absolute inequalities by 25% during 1999-2006. However, in case of children underweight, the results showed divergence with an increase in AID by 6% during 1992-1999 and 13% in
16.2 16.1
11.6
10.4
0 2 4 6 8 10 12 14 16 18
1981 1991 2001 2009
Standard deviation
Pe riod
NNMR
178 1999-2006. Overall, the results showed increasing divergence in children underweight across the Indian states. The percentage reduction in absolute inequality, measured by DMM, in NNMR was declined until 2001. During 2001-09, the earlier convergence was replaced with divergence. The volume of convergence in overall absolute inequality in NNMR during 1981-1991 was 15%, which increased to 31% during 1991-2001, but become negative during 2001-2009 (-8.3%). However, in contrast to children full immunisation, the results of convergence in absolute inequality for NNMR revealed a trend of convergence replacing divergence for NNMR, a continued and increasing divergence trend for children underweight.
Figure 7.5a. Trends of percentage of absolute convergence in Children immunisation, Children underweight, NNMR among major Indian states, 1981-2009
Children full immunisation
-31.7
25.4
-40.0 -30.0 -20.0 -10.0 0.0 10.0 20.0 30.0
1992-1999 1999-2006
Percent of absolute inequality convergence
1992-1999 1999-2006
179 Children underweight
NNMR
Convergence in relative overall inequality in child health was measured by Gini coefficient based on reduction in percentage of Gini for children full immunisation, children underweight and NNMR. The results in case of children full immunisation reveal divergence in relative inequalities in 1992-93, but the divergence was replaced with convergence in later period, 1999-2006. However, both children underweight and NNMR showed continued divergence in relative inequalities for the entire period, 1981-2009 that the rate of percentage reduction in Gini coefficient was negative for all three periods. The estimates of the relative convergence showed greater divergence in children underweight
-6.1
-13.3 -14
-12 -10 -8 -6 -4 -2 0
1992-1999 1999-2006
Percent of absolute inequality convergence
15.5
34.9
-8.3 -15
-10 -5 0 5 10 15 20 25 30 35 40
1981-1991 1991-2001 2001-2009
Percentage of absolute inequality convergence
NNMR convergence rate
180 than in NNMR. However, there was a steady decline (from -5% to -2.5%) in the volume of divergence for NNMR, but increasing (from -20 to -29%) for children underweight. In sum, the relative convergence in overall health inequality showed evidence of divergence than convergence, in two out three indicators (Figure 7.5b).
Figure.7.5b. Trends in convergence in relative inequalities based on the Gini estimates among the major states of India, 1981-2009
Children full immunisation
Children underweight
-18.41
31.12
-30 -20 -10 0 10 20 30 40
1992-1999 1999-2006
Percentage of relative inequality convergence
Gini Index
-20.27
-29.43 -35
-30 -25 -20 -15 -10 -5 0
1992-1999 1999-2006
Percentage of relative inequality convergence
Gini Index
181 NNMR
Figure 7.5c. Trends in percentage of absolute inequality convergence in Children full immunisation, Children underweight, NNMR among major Indian states by Rural-Urban, 1981-2009
Children full immunisation, Rural
-5.17
-3.30
-2.52
-6 -5 -4 -3 -2 -1 0
1981-1991 1991-2001 2001-2009
Percetnage of relative inequality convergence
Relative convergence of NNMR
-25.97
23.65
-30 -20 -10 0 10 20 30
1992-1999 1999-2006
Percentage of absolute inequality convergence
AID
182 Children full immunisation, Urban
Children underweight, Rural
-7.22
0.35
-8 -7 -6 -5 -4 -3 -2 -1 0 1
1992-1999 1999-2006
Percentage of absolute inequality convergence
AID
-3.0
-13.6 -16
-14 -12 -10 -8 -6 -4 -2 0
1992-1999 1999-2006
Percentage of absolute inequality convergence
AID