Health Infrastructure and Immunization Coverage in Rural India

Background & objectives: Vaccination coverage in India is far from complete despite the commitment to universal coverage. In this study, we examine the role of health infrastructure in expanding immunization coverage in rural India. Our approach differs from prior work in that we include detailed measures of village health infrastructure that account for the wide variations in health care capabilities across facilities. Methods: The analysis sample consists of 43,416 children aged 2-35 months residing in rural India from the National Family Health Survey conducted in 1993 and 1998 respectively. We estimate separate multinomial logit regression models for polio and non-polio vaccines that estimate the probability that a child will receive “no cover,” “some cover” or “full age-appropriate cover.” The key measure of health infrastructure is a hierarchical variable that assigns each child to categories (no facility; dispensary or clinic; sub center; primary health care center (PHC); hospital) based on the best health facility available in the child’s village. Results: In 1993, roughly 45 percent of children in rural India had no immunization coverage for polio and non-polio vaccines and 43 percent of children lived in villages with no health facility. The estimates from the regressions show that availability of health infrastructure in the village significantly improved vaccination coverage for nonpolio vaccines. The estimates also show that larger and better-equipped facilities such as PHCs or hospitals have a bigger effect on vaccine coverage. The association between the best health facility available in the village and polio vaccine coverage was small and statistically insignificant. One notable exception is that having a PHC or hospital within 2 or 5 km significantly increased the likelihood of full-cover for polio vaccine.