Interactive Impact Of Health Expenditure And Governance On Under-Five Mortality: A Panel Evidence From Sub-Saharan Africa

• Alekeu Taye

  Post graduate student, Department of Economics and Development studies Federal University Kashere, Gombe State-Nigeria

  Author

• Idowu Daniel Onisanwa

  Department of Economics and Development studies, Faculty of social sciences, Federal University Kashere, Gombe State-Nigeria

  Author

• Ali Madina Dankumo

  Department of Economics and Development studies, Faculty of social sciences, Federal University Kashere, Gombe State-Nigeria

  Author

This study examines the interactive impact of health expenditure and governance on under-five mortality in Sub-Saharan Africa over the period 2000–2023. The study utilizes secondary data obtained from the World Bank’s World Development Indicators (WDI).Methodologically, the study adopts the Generalized Method of Moments (GMM) estimation technique, which is suitable for addressing potential endogeneity, unobserved heterogeneity, and dynamic relationships inherent in panel data analysis. The study distinguishes between domestic public and private health expenditure while incorporating governance as a critical institutional factor influencing health outcomes. The empirical findings reveal that domestic public health expenditure has a negative and statistically significant effect on under-five mortality at the 5% level. Specifically, a one-unit increase in public health spending leads to a 0.8-unit reduction in under-five mortality, In contrast, domestic private health expenditure shows a negative but statistically insignificant relationship with under-five mortality, suggesting that private spending does not exert a substantial independent influence on mortality reduction. Governance is also found to have a negative and statistically significant effect on under-five mortality, with a one-unit improvement in governance reducing mortality by approximately 0.08 units. Furthermore the result reveals that, the interaction between domestic public health expenditure and governance is negative and statistically significant, indicating that the effectiveness of public health spending is amplified in environments characterized by strong governance. A one-unit increase in the combined effect reduces under-five mortality by 0.34 units. Conversely, the interaction between domestic private health expenditure and governance is negative but statistically insignificant, implying a limited joint effect on mortality outcomes, likely due to structural inequalities and the predominance of out-of-pocket financing. The study concludes that while increasing public health expenditure is essential for reducing under-five mortality, its impact is significantly strengthened by improved governance. Policy efforts should therefore prioritize both increased public investment in health and the strengthening of governance frameworks to achieve sustainable improvements in child health outcomes in Sub-Saharan Africa. 

• Download PDF