Factors influencing inequality in government health expenditures within African regional economic communities.

BACKGROUND: The unequal distribution of government health spending within African regional economic groupings is a significant barrier to achieving Universal Health Coverage and reaching health-related Sustainable Development targets. It also hampers the progress toward achieving the African Union's vision of an integrated and prosperous Africa, free of its heavy disease burden. Based on panel data from 36 countries nested into eight Regional Economic Communities (RECs), this study probes the effects of countries' macro-level factors on government health expenditure disparities within eight regional economic communities from 2000 to 2019. METHOD: We use the multilevel linear mixed-effect method to show whether countries' trade gains, life expectancy at birth, poverty, urbanization, information and communication technology, and population aging worsen or reduce the differences for two government health expenditure indicators. RESULTS: The insignificant effect of GDP per capita suggests that in most regional economic groupings, the health sector is still not considered a high-priority sector regarding overall government expenditures. Countries' poverty levels and urbanization increase the domestic general government health expenditure disparities as a percentage of general government expenditure within the regional groupings. However, trade gains and ICT diffusion reduce these disparities. Furthermore, the results reveal that external health expenditure per capita and life expectancy at birth positively impact within-regional inequalities in the domestic general government health expenditure per capita. In contrast, GDP per capita and trade gains tend to reduce them. CONCLUSIONS: This study enriches the research on the determinants of government health expenditure inequality in Africa. Policies that can spur growth in trade and ICT access should be encouraged. Countries should also make more efforts to reduce poverty. Governments should also develop policies promoting economic growth and planned urbanization.

Health outcome convergence in Africa: the roles of immunization and public health spending.

BACKGROUND: Reducing health outcomes disparities in Africa is a major concern for policymakers. Inter-country disparities in Africa is well documented. However, little is known about the accurate trajectory of these disparities over time. Thus, this paper investigates the convergence hypothesis in health outcomes in 40 African countries using data from the World Development Indicators. The study used panel data from 2000 to 2019. METHOD: The study employs a nonlinear time-varying factor model to test the convergence hypothesis on infant mortality rate, under-five mortality, and life expectancy at birth. Then, we use the marginal effects of the ordered logit regression model to investigate the factors that explain club memberships. RESULTS: The findings showed the absence of overall convergence for the three variables of interest. However, we identified the presence of convergence clubs. Moreover, we observed substantial gaps between the estimated clubs. The marginal effect results reveal that real GDP per capita, population structure, urbanization, trade, access to basic sanitation, and external health expenditure are essential to club formation. In addition, DTP immunization and the general government health expenditure as a percentage of the general government expenditure (our Abuja Declaration instrument) also play a significant role in explaining the club membership. CONCLUSION: The findings suggest that policymakers should develop and implement targeted club-specific health policies. Furthermore, interventions to promote increased immunization, particularly among children, should be encouraged. Governments should also make substantial efforts to increase the share of their national budget allocated to the health sector by at least 15 percent.

Health expenditure convergence and the roles of trade and governance in Africa.

This study investigates the convergence hypothesis in health expenditures in 40 African countries over the 2000-2019 period. The new non-linear dynamic factor model is used on panel data extracted from the World Development Indicator and the World Governance Indicator. We consider two categories of health expenditures: the domestic general government health expenditure as a percentage of government expenditure and the domestic general government health expenditure per capita. The results show the absence of full panel convergence for the two indicators used. However, there is evidence of convergence clubs. The overall marginal effect of the control variables is consistent with the existing literature. The results further show a strong influence of trade in attaining convergence among the clubs for both models. However, governance quality only affects the probability of converging in a club for the general government health expenditure as a percentage of government expenditure model. The findings suggest that policies on promoting health expenditure convergence should pursue initiatives that encourage trade. Efforts should also be targeted to improve the quality of governance.