Submission ID 130283
| Issue/Objective | Achieving Sustainable Development Goal Target 3.2, which aims to end preventable deaths among children under five by 2030, will depend not only on increasing health expenditure but also on ensuring that public health financing remains stable and predictable over time. While a substantial literature documents the mortality-reducing effects of higher government health expenditure, little is known about whether instability in public health financing independently undermines child survival. Sub-Saharan Africa (SSA), where fiscal volatility is common and under-five mortality remains the highest globally, provides a critical context for examining this question. |
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| Methodology/Approach | This study uses a balanced panel of 45 SSA countries from 2000 to 2023. Government health expenditure volatility is measured as the five-year rolling standard deviation of per capita public health spending. The dependent variable is the under-five mortality rate. Pooled OLS, one-way fixed effects, and two-way fixed effects models are estimated with country-clustered standard errors. A two-year lag structure is employed to mitigate reverse causality, supported by a placebo regression using a two-year lead of the volatility measure. Heterogeneous effects are examined across World Bank income groups, and robustness is assessed using an alternative volatility measure based on the coefficient of variation. |
| Results | Government health expenditure volatility is positively and significantly associated with under-five mortality across all specifications. In the preferred two-way fixed effects model, a one standard deviation increase in financing volatility is associated with approximately a 1.8% increase in under-five mortality, controlling for spending levels and socioeconomic factors. Heterogeneity analysis reveals a pronounced income gradient: the effect is statistically insignificant in low-income countries but becomes economically larger and statistically significant in lower-middle and upper-middle-income countries. Robustness checks confirm the stability of the main findings. |
| Discussion/Conclusion | The findings demonstrate that not only the level but also the predictability of public health financing matters for child survival in SSA. Health financing instability constitutes an independent risk factor for under-five mortality, particularly in countries with more developed health systems. Strengthening budget predictability and building countercyclical health financing mechanisms may therefore be critical for sustaining progress toward child mortality reduction and achieving SDG targets in the region. |
| Presenters and Affiliations | Kwadwo Arhin University of Skills Training and Entrepreneurial Development Richard Kwasi Boso Ghana Institute of Management and Public Administration |
