Rain, Roads and Health : A Spatial Investigation of How Accessibility Influences Health-Seeking Behavior in Rural Liberia
(2025) MIDM19 20231Department of Human Geography
LUMID International Master programme in applied International Development and Management
- Abstract
- An extensive public health literature has linked the low take-up of healthcare services in developing countries with measures of accessibility such as distance, duration and cost of travel to the nearest health facility. However, causality has been difficult to prove, given the endogeneity of factors influencing access, such as the availability and quality of roads and transportation. Using a natural experiment research design, this study exploits rain-induced exogenous variation in the road conditions of rural Liberia to support a causal impact of accessibility on health-seeking behavior. Most roads in Liberia have an unpaved surface, and their practicability can be greatly disrupted by rainfall. The hypothesis is that during heavy rain... (More)
- An extensive public health literature has linked the low take-up of healthcare services in developing countries with measures of accessibility such as distance, duration and cost of travel to the nearest health facility. However, causality has been difficult to prove, given the endogeneity of factors influencing access, such as the availability and quality of roads and transportation. Using a natural experiment research design, this study exploits rain-induced exogenous variation in the road conditions of rural Liberia to support a causal impact of accessibility on health-seeking behavior. Most roads in Liberia have an unpaved surface, and their practicability can be greatly disrupted by rainfall. The hypothesis is that during heavy rain households relying on predominantly unpaved routes to reach their health provider would be more impacted in their health-seeking decisions, after controlling for other factors. The analysis combines primary household survey data on illness episodes with road surface quality metrics based on OpenStreetMap. Residual rain, defined as the rain amount after subtracting the historical monthly average, was derived from U.S. National Oceanic and Atmospheric Administration records.
Findings show that residual rain on unpaved roads significantly reduces the likelihood of seeking treatment outside the home, increases treatment delays, and raises the probability of being unable to fully treat a condition. Women are disproportionately affected, with lower rates of seeking care and of fully treating their conditions, while greater household wealth and more education of the household head are associated with improved health-seeking behavior. Preliminary evidence suggests that rainfall increasing travel costs and creating impassable road segments may be mechanisms through which reduced road accessibility deters health-seeking behavior. (Less)
Please use this url to cite or link to this publication:
http://lup.lub.lu.se/student-papers/record/9184679
- author
- Vasilov, Camelia LU
- supervisor
- organization
- course
- MIDM19 20231
- year
- 2025
- type
- H2 - Master's Degree (Two Years)
- subject
- keywords
- Health-seeking behavior, accessibility, natural experiment, Liberia
- language
- English
- id
- 9184679
- date added to LUP
- 2025-02-10 16:54:19
- date last changed
- 2025-02-10 16:54:19
@misc{9184679,
abstract = {{An extensive public health literature has linked the low take-up of healthcare services in developing countries with measures of accessibility such as distance, duration and cost of travel to the nearest health facility. However, causality has been difficult to prove, given the endogeneity of factors influencing access, such as the availability and quality of roads and transportation. Using a natural experiment research design, this study exploits rain-induced exogenous variation in the road conditions of rural Liberia to support a causal impact of accessibility on health-seeking behavior. Most roads in Liberia have an unpaved surface, and their practicability can be greatly disrupted by rainfall. The hypothesis is that during heavy rain households relying on predominantly unpaved routes to reach their health provider would be more impacted in their health-seeking decisions, after controlling for other factors. The analysis combines primary household survey data on illness episodes with road surface quality metrics based on OpenStreetMap. Residual rain, defined as the rain amount after subtracting the historical monthly average, was derived from U.S. National Oceanic and Atmospheric Administration records.
Findings show that residual rain on unpaved roads significantly reduces the likelihood of seeking treatment outside the home, increases treatment delays, and raises the probability of being unable to fully treat a condition. Women are disproportionately affected, with lower rates of seeking care and of fully treating their conditions, while greater household wealth and more education of the household head are associated with improved health-seeking behavior. Preliminary evidence suggests that rainfall increasing travel costs and creating impassable road segments may be mechanisms through which reduced road accessibility deters health-seeking behavior.}},
author = {{Vasilov, Camelia}},
language = {{eng}},
note = {{Student Paper}},
title = {{Rain, Roads and Health : A Spatial Investigation of How Accessibility Influences Health-Seeking Behavior in Rural Liberia}},
year = {{2025}},
}