72 CHAPTER 4
have affected subsequent changes in the numbers of community-level health- care personnel after 1994, given the fact that South Africa has attempted to build healthcare facilities and increase the number of healthcare personnel in the post-apartheid period. However, it is hard to show quantitative evidence for this conjecture from our sample.
In the following estimation, I interact child age with the initial number of healthcare personnel to capture dynamic changes in the personnel specific to a given community. For example, if a nurse was not in the community in 1993, it is likely that the community would have nurses in the subsequent period. Therefore, the interaction between the initial availability of health- care personnel and child age (cohort) captures community-specific changes in healthcare conditions.9 Another advantage of interacting the healthcare information with child age comes from the fact that nutrition input is most important in children under 3 years of age, an outcome measured by height in our context. The impact of healthcare on height differs by child age. The individual-level variations, created by age, make it feasible to examine intra- household (within-sibling) variations in health and schooling outcomes in the household fixed-effect model.
However, we also notice a possibility that dynamic changes in healthcare and education facilities are correlated, though both sets of changes were slow to occur at the beginning of the post-apartheid government. In the first stage, we are concerned with the impact of potential changes in health infra- structure on the health outcomes of the sample children during the period 1993–98, while their schooling outcomes were directly affected by changes in education infrastructure in 1998–2004. This time gap may justify the use of the 1993 initial health infrastructure data (personnel availability) as a potential source of intercommunity variations. However, to the extent that (changes in) healthcare facilities and schools are correlated, the proposed instrument is invalid.
indicators. This period also corresponds to the abolishment of apartheid, so new economic opportunities were presented to the African population. On the other hand, unrest associated with the transition was particularly violent in the province of KwaZulu-Natal. Thus there could have been positive impacts as well as negative ones. In addition, to capture the heterogene- ity in the impacts related to the initial income level, the indicator is also interacted with total monthly household income in 1993. Although an F-test supports the joint significance of these instruments in explaining variations among siblings in height-for-age z-scores, a Hausman-Wu test rejects the relevance of these instruments. We observed some differences between within- sibling OLS and within-sibling instrumental-variable estimates, but the magnitude did not alter
the qualitative nature of our results. 9 Age distribution is potentially endogenous, correlated with private information on policy changes that parents might have had when the society moved into the post-apartheid regime. Parents might have changed reproductive behavior and their fertility might have changed; these factors affect birth timing and therefore the initial health conditions for their children.
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