The effectiveness of public health spending in Sub-Saharan Africa.

Abstract

This research conducted a thorough analysis of the effectiveness of public health spending (PHS) in enhancing population health outcomes (PHO) across sub-Saharan African (SSA) countries. Implementing PHS interventions in these countries faces challenges due to the disregard of critical intermediate factors that are specific to them. These factors include high prevalence of infectious diseases, inadequate immunization coverage, inefficiencies in the health system, governance issues, low levels of education, and underlying processes. Consequently, although the diligent allocation of financial resources towards enhancing health, PHO in the region persistently lag behind those of other global regions. This research aims to investigate the role of the above-mentioned intermediaries as transmission mechanisms of PHS and understand how these intermediaries interact with PHS to shape the effectiveness of PHS intervention. Moreover, the research assesses the benefits of using disaggregated data for measuring PHS. To achieve its objectives, the research employed panel data from selected SSA countries and applied several quantitative methodologies, such as longitudinal growth curve mediation modelling, partial least squares structural equation modelling, and system generalised method of moments. These approaches were chosen owing to the characteristics of the different processes investigated. The findings show that malaria incidence and female education, as indicators of infectious disease burdens and education, work sequentially as the transmission mechanism of PHS, while no indication of immunisation as a mediator was found. The findings also show that health system efficiency (HSE) and country governance are moderating factors in the PHS-PHO relationship, with weaker HSE or governance adversely affecting PHS effectiveness. Additionally, disaggregated data measuring PHS is shown to offer better evidence of PHS effectiveness. In conclusion, the research highlights the significant role of structural factors specific to SSA in shaping the effectiveness of PHS in improving PHO in the region. Its findings underscore the imperative of integrating these factors into the development of PHS interventions in SSA. The research provides invaluable insights into the complex nature of PHS effectiveness in SSA and proposes avenues for more targeted and impactful PHS interventions.