Do Women’s Parliamentary Representation Increase Government Health Spending in Sub-Saharan Africa?

IntroductionGovernment health spending is a primary source of funding in the health sector across the world. However, in sub-Saharan Africa, only about a third of all health spending is sourced from the government. The objectives of this study are to describe the growth in government health spending, examine its determinants and explain the variation in government health spending across sub-Saharan African countries.MethodsWe used panel data on domestic government health spending in 46 countries in sub-Saharan Africa from 1995 to 2015 from the Institute for Health Metrics and Evaluation. A regression model was used to examine the factors associated with government health spending, and Shapley decomposition was used to attribute the contributions of factors to the explained variance in government health spending.ResultsWhile the growth rate in government health spending in sub-Saharan Africa has been positive overall, there are variations across subgroups. Between 1995 and 2015, government health spending in West Africa grew by 6.7% (95% uncertainty intervals [UI]: 6.2% to 7.0%) each year, whereas in Southern Africa it grew by only 4.5% (UI: 4.5% to 4.5%) each year. Furthermore, per-person government health spending ranged from $651 (Namibia) in 2017 purchasing power parity dollars to $4 (Central African Republic) in 2015. Good governance, national income and the share of it that is government spending were positively associated with government health spending. The results from the decomposition, however, showed that individual country characteristics made up the highest percentage of the explained variation in government health spending across sub-Saharan African countries.ConclusionThese findings highlight that a country’s policy choices are important for how much the health sector receives. As the attention of the global health community focuses on ways to stimulate domestic government health spending, an understanding that individual country sociopolitical context is an important driver for success will be key.

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Exploring country-wide equitable government health care facility access in Uganda

International Journal for Equity in Health ◽

10.1186/s12939-020-01371-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Nicholas Dowhaniuk

Keyword(s):

Health Care ◽

Random Forest ◽

Health Center ◽

Travel Time ◽

Health Centers ◽

Sub Saharan Africa ◽

Walking Distance ◽

Laboratory System ◽

Government Health ◽

Sub Saharan

Abstract Background Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor. Methods An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking, bicycling, and driving scenarios. Statistically significant clusters of high and low travel time to health centers were calculated using spatial statistics. Random Forest analysis was used to explore the relationship between poverty, population density, health center access in minutes, and time saved in travel to health centers using a bicycle instead of walking. Linear Mixed-Effects Models were then used to validate the performance of the random forest models. Results The percentage of Ugandans within a one-hour walking distance of the nearest health center II is 71.73%, increasing to 90.57% through bicycles. Bicycles increased one-hour access to the nearest health center III from 53.05 to 80.57%, increasing access to the tiered integrated national laboratory system by 27.52 percentage points. Significant clusters of low health center access were associated with areas of high poverty and urbanicity. A strong direct relationship between travel time to health center and poverty exists at all health center levels. Strong disparities between urban and rural populations exist, with rural poor residents facing disproportionately long travel time to health center compared to wealthier urban residents. Conclusions The results of this study highlight how the most vulnerable Ugandans, who are the least likely to afford transportation, experience the highest prohibitive travel distances to health centers. Bicycles appear to be a “pro-poor” tool to increase health access equity.

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A study on the Analysis of the Effects of Government Health Expenditure on Maternal Mortality in 25 Sub-Saharan Africa Countries

10.7176/ppar/9-9-09 ◽

2019 ◽

Keyword(s):

Maternal Mortality ◽

Health Expenditure ◽

Sub Saharan Africa ◽

Government Health ◽

Sub Saharan ◽

Government Health Expenditure

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Corruption, Government Effectiveness and Human Development in Sub-Saharan Africa

Journal for the Advancement of Developing Economies ◽

10.32873/unl.dc.jade912 ◽

2020 ◽

pp. 16-34

Author(s):

Sakiru Akinbode ◽

Jayeola Olabisi ◽

Remilekun Adegbite ◽

Timothy Aderemi ◽

Abimbola Alawode

Keyword(s):

Human Development ◽

Health Sector ◽

Health Spending ◽

Joint Effect ◽

Least Square ◽

Sub Saharan Africa ◽

Method Of Moment ◽

Government Effectiveness ◽

Lagged Dependent Variable ◽

Sub Saharan

Aside economic factors causing low human development which have been extensively studied in literature, the implications of high level of corruption and weak governance prevalent in sub- Saharan African (SSA) countries have not been explored. The study assessed the effects of corruption, government effectiveness and their joint effect on human development in SSA. Data collected on thirty-seven (37) countries within the period of 2005 to 2018 were analyzed using system Generalized Method of Moment which was most suitable for the dataset. Results indicated that lagged human development index (P<0.01), government effectiveness (P<0.05), economic growth rate (P<0.1) and government health spending (P<0.1) had significant positive effect on human development while corruption and its interaction with government effectiveness did not. The results of Arrelano-Bond test of first order autocorrelation and second order autocorrelation of error term as well as the Sargan test and Hansen J test for validity of instrumental variables confirmed the validity of the model. The robustness of the estimation was established as the coefficient of the lagged dependent variable fell between the values in the fixed effect and pooled ordinary least square regression. The study recommended retraining and reorientation of government employees towards the mindset of effective service delivery and strong political will to achieve it, diversification of SSA economies alongside other growth stimulating policies such as reduced lending interest rate on loans meant for the real sector, improvement in the ease of doing business, improved funding of the health sector and proper monitoring of activities in the public service by concerned agencies to curb corruption where it is present.

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Do Political Factors affect Government Health Spending? Empirical Evidence from Sub-Sahara African Countries

Advances in Politics and Economics ◽

10.22158/ape.v3n2p57 ◽

2020 ◽

Vol 3 (2) ◽

pp. p57

Author(s):

Issa Dianda

Keyword(s):

Public Health ◽

Health Care ◽

Health Expenditure ◽

Public Spending ◽

Health Spending ◽

Political Stability ◽

Sub Saharan Africa ◽

Political Factors ◽

Government Health ◽

Out Of Pocket Payments

In Sub-Saharan Africa (SSA), access to essential health care services remains problematic. The financing of health care is mainly provided by private sources, mainly out-of-pocket payments which represent respectively 53.12% and 36.73% of total health expenditure in 2016. As for public health expenditure, essential for ensuring universal health coverage, it represents only about 35% of health expenditure. Thus, the increase in public spending on health from domestically sources proves to be a major challenge for the countries of the region in the prospect of reaching the SDG relating to health by 2030. This paper aims to analyse the determinants of domestic government health spending in SSA by focusing on political factors. We use data from 39 SSA countries covering the period 2010-2016 and panel-corrected standard errors method for empirical investigation. The results show that democracy favours an increase in government health spending. Furthermore, a political competitive environment, the guarantee and the protection of civil liberties and political right, accountability, government effectiveness and political stability are decisive for increasing government health spending. The results also showed that political participation does not affect public health spending. These results indicate that improving political factors is essential to increase public spending in SSA.

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HEALTH AID, PUBLIC AND PRIVATE HEALTH SPENDING IN SUB SAHARAN AFRICA (SSA): NEW EVIDENCE FROM PANEL DATA ANALYSIS

African Journal of Health Economics ◽

10.35202/ajhe.2018.7103 ◽

2018 ◽

Vol 7 (1) ◽

pp. 01-09

Author(s):

UCHE ABAMBA OSAKEDE

Keyword(s):

Data Analysis ◽

Panel Data ◽

Panel Data Analysis ◽

Health Spending ◽

Sub Saharan Africa ◽

Public And Private ◽

Health Aid ◽

Sub Saharan ◽

New Evidence

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Does the implementation of UHC reforms foster greater equality in health spending? Evidence from a benefit incidence analysis in Burkina Faso

BMJ Global Health ◽

10.1136/bmjgh-2021-005810 ◽

2021 ◽

Vol 6 (12) ◽

pp. e005810

Author(s):

Manuela De Allegri ◽

Martin Rudasingwa ◽

Edmund Yeboah ◽

Emmanuel Bonnet ◽

Paul André Somé ◽

...

Keyword(s):

Burkina Faso ◽

Public Spending ◽

Health Spending ◽

Household Survey ◽

Sub Saharan Africa ◽

Health Coverage ◽

Delivery Services ◽

Distributional Incidence ◽

Sub Saharan ◽

Health Accounts

IntroductionBurkina Faso is one among many countries in sub-Saharan Africa having invested in Universal Health Coverage (UHC) policies, with a number of studies have evaluated their impacts and equity impacts. Still, no evidence exists on how the distributional incidence of health spending has changed in relation to their implementation. Our study assesses changes in the distributional incidence of public and overall health spending in Burkina Faso in relation to the implementation of UHC policies.MethodsWe combined National Health Accounts data and household survey data to conduct a series of Benefit Incidence Analyses. We captured the distribution of public and overall health spending at three time points. We conducted separate analyses for maternal and curative services and estimated the distribution of health spending separately for different care levels.ResultsInequalities in the distribution of both public and overall spending decreased significantly over time, following the implementation of UHC policies. Pooling data on curative services across all care levels, the concentration index (CI) for public spending decreased from 0.119 (SE 0.013) in 2009 to −0.024 (SE 0.014) in 2017, while the CI for overall spending decreased from 0.222 (SE 0.032) in 2009 to 0.105 (SE 0.025) in 2017. Pooling data on institutional deliveries across all care levels, the CI for public spending decreased from 0.199 (SE 0.029) in 2003 to 0.013 (SE 0.002) in 2017, while the CI for overall spending decreased from 0.242 (SE 0.032) in 2003 to 0.062 (SE 0.016) in 2017. Persistent inequalities were greater at higher care levels for both curative and institutional delivery services.ConclusionOur findings suggest that the implementation of UHC in Burkina Faso has favoured a more equitable distribution of health spending. Nonetheless, additional action is urgently needed to overcome remaining barriers to access, especially among the very poor, further enhancing equality.

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RTS,S/AS01, a vaccine targeting pre-erythrocytic stages of Plasmodium falciparum

Emerging Topics in Life Sciences ◽

10.1042/etls20170101 ◽

2017 ◽

Vol 1 (6) ◽

pp. 533-537

Author(s):

Lorenz von Seidlein ◽

Borimas Hanboonkunupakarn ◽

Podjanee Jittmala ◽

Sasithon Pukrittayakamee

Keyword(s):

Protective Efficacy ◽

Age Groups ◽

Sub Saharan Africa ◽

Phase Iii ◽

European Medicines Agency ◽

Older Children ◽

Pivotal Phase ◽

Malaria Epidemiology ◽

Maximum Benefit ◽

Sub Saharan

RTS,S/AS01 is the most advanced vaccine to prevent malaria. It is safe and moderately effective. A large pivotal phase III trial in over 15 000 young children in sub-Saharan Africa completed in 2014 showed that the vaccine could protect around one-third of children (aged 5–17 months) and one-fourth of infants (aged 6–12 weeks) from uncomplicated falciparum malaria. The European Medicines Agency approved licensing and programmatic roll-out of the RTSS vaccine in malaria endemic countries in sub-Saharan Africa. WHO is planning further studies in a large Malaria Vaccine Implementation Programme, in more than 400 000 young African children. With the changing malaria epidemiology in Africa resulting in older children at risk, alternative modes of employment are under evaluation, for example the use of RTS,S/AS01 in older children as part of seasonal malaria prophylaxis. Another strategy is combining mass drug administrations with mass vaccine campaigns for all age groups in regional malaria elimination campaigns. A phase II trial is ongoing to evaluate the safety and immunogenicity of the RTSS in combination with antimalarial drugs in Thailand. Such novel approaches aim to extract the maximum benefit from the well-documented, short-lasting protective efficacy of RTS,S/AS01.

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