Public Health Expenditure and Under-Five Mortality in Low-Income Sub-Saharan African Countries: A Panel Data Analysis

Abstract

Background: In the year 2019 whiles the total world under-five mortalities was estimated at about 5.2 million, Sub-Saharan Africa contributed about 55% of these global under-five mortalities. In other words, the region alone recorded about 2.8 million under-five deaths out of the global 5.2 million under-five mortalities in 2019. On the other hand, public health expenditure in Sub-Saharan Africa though very low as compared to other regions has also seen a steady increase over the years. This has resulted in an increased interest of researchers and policymakers in scrutinizing the effect of healthcare spending on health status in Sub-Saharan Africa's low-income countries. This study, therefore, investigated the association between public healthcare spending and the under-five mortality rate in low-income countries of Sub-Saharan Africa.

Methods: A balanced panel of data from twenty low-income countries in Sub-Saharan Africa was sourced from the World Development Indicators dataset spanning the year 2000 to 2019. The under-5 mortality rate was used as the outcome variable whereas domestic health expenditure was used as the independent variable of interest. Total fertility rate, percentage population of females, the practice of open defecation, and immunization against diphtheria-pertussis-tetanus (DPT) were considered potential confounding variables. The static model was applied. To arrive at the appropriate model for the study, the robust Hausman test was employed to aid in the selection between the random effect estimator and the fixed effect estimator, and the results led to the selection of the fixed effect estimator.

Results: The results showed that domestic health spending has a significantly negative relationship (Fixed Effects= -5.275; p<0.05) with the under-five mortality rate in low-income countries of Sub-Saharan Africa. For every additional percentage increase in domestic health spending, it is likely to result in about 5.3 units fall in under-five mortality rate. Total fertility rate, female population, and rural people practicing open defecation were positively associated while immunization against DPT was negatively associated (p<0.01) with an under-5 mortality rate.

Conclusion: The study revealed a strong relationship between domestic health spending and the under-five mortality rate. We conclude that a sustained increase in health expenditure and improvement in social conditions are required to reduce under-5 mortalities within low-income countries of Sub-Saharan Africa.

Note:
Funding Information: The study did not benefit from any source of funding.

Declaration of Interests: We declare that we have no competing interest.

Keywords: Under-five mortality rate, domestic health spending, low-income Sub-Saharan Africa countries, panel data, fixed effect and random effect.