The impact of antiretroviral treatment and child-focused unconditional cash transfers on child mortality.

Although there is sufficient evidence in the epidemiological literature that antiretroviral treatment (ART) reduces child mortality, there is limited evidence of its effect in the socio-economic determinants of child mortality literature. Furthermore, evidence on the effect of child focused unconditional cash transfers (UCTs) on child mortality is limited, especially in the African context. Using South Africa's provincial level data over the period 2001 to 2019, we evaluate the effect of ART and child focused UCTs on child mortality. We use the two-stage instrumental variable mean group estimator. We find that ART reduces child mortality. Moreover, we find an inverted U-shaped non-linear relationship between UCTs and child mortality that is contingent to the level of cash transfer coverage. Our analyses also reveal that UCTs improve the effect of ART on child mortality by enhancing access and adherence to treatment. While the focus of our analyses was on the child mortality effects of ART and UCTs, our findings reaffirm the well-documented impacts of factors such as public health expenditure, HIV/AIDS, female education, and health worker density on child mortality. Collectively, the combination of high ART and UCTs coverage, increased public health expenditure, enhanced female education, and improved health worker density, represents value for money for policymakers and funders. These areas should be prioritised to improve child well-being.

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.

Trends in household out-of-pocket health expenditures and their underlying determinants: explaining variations within African regional economic communities from countries panel data.

BACKGROUND: The persistently high out-of-pocket health spending (OOPHE) in Africa raise significant concern about the prospect of reaching SDG health targets and UHC. The study examines the convergence hypothesis of OOPHE in 40 African countries from 2000 to 2019. METHODS: We exploit the log t , club clustering, and merging methods on a panel of dataset obtained from the World Development Indicators, the World Governance Indicators, and the World Health Organization. Then, we employ the multilevel linear mixed effect model to examine whether countries' macro-level characteristics affect the disparities in OOPHE in the African regional economic communities (RECs). RESULTS: The results show evidence of full panel divergence, indicating persistent disparities in OOPHE over time. However, we found three convergence clubs and a divergent group for the OOPHE per capita and as a share of the total health expenditure. The results also show that convergence does not only occur among countries affiliated with the same regional economic grouping, suggesting disparities within the regional groupings. The findings reveal that countries' improved access to sanitation and quality of governance, increased childhood DPT immunization coverage, increased share of the elderly population, life expectancy at birth, external health expenditure per capita, and ICT (information and communication technology) significantly affect within-regional groupings' disparities in OOPHE per capita. The results also show that an increasing countries' share of elderly and younger populations, access to basic sanitation, ICT, trade GDP per capita, life expectancy at birth, childhood DPT immunization coverage, and antiretroviral therapy coverage have significant impacts on the share of OOPHE to total health expenditure within the regional groupings. CONCLUSION: Therefore, there is a need to develop policies that vary across the convergence clubs. These countries should increase their health services coverage, adopt planned urbanization, and coordinate trade and ICT access policies. Policymakers should consider hidden costs associated with access to childhood immunization services that may lead to catastrophic health spending.

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.

The impact of child mortality on fertility in South Africa: Do child support grants and antiretroviral treatment matter?

This paper investigates the effect of under-five mortality, child support grant (CSG) coverage and the rollout of antiretroviral therapy (ART) on fertility in South Africa. The study employs the quality-quantity trade-off framework to analyse the direct and indirect factors affecting fertility using the two stage least squares fixed effects instrumental variable approach. The analysis uses balanced panel data covering nine provinces from 2001-2016. This period was characterised by significant increases in the child support grant coverage and ART coverage. Furthermore, this period was characterised by a significant decline in the under-five mortality rate. We find no evidence to support the hypothesis that increases in the CSG coverage are associated with an increase in fertility. This finding aligns with previous literature suggesting that there are no perverse incentives for childbearing associated with the child support grant. On the other hand, results indicate that an increase in ART coverage is associated with an increase in fertility. Results also show that a decrease in under-five mortality is associated with a decline in fertility over the sample period. HIV prevalence, education, real GDP per capita, marriage prevalence and contraceptive prevalence are also important determinants of fertility in South Africa. Although the scale up of ART has improved health outcomes, it also appears to have increased fertility in HIV-positive women. The ART programme should therefore be linked with further family planning initiatives to minimise unintended pregnancies.

Convergence in renewable energy consumption and their influencing factors across regions: evidence from convergence algorithm approach.

This study examines the convergence in renewable energy consumption over the period 2000-2018 by using a convergence algorithm developed by Phillips and Sul. We used 183 countries which were sub-divided into five regions, namely: Sub-Saharan Africa (SSA); Middle East and North Africa (MENA); Europe and Central Asia (ECA); East and South Asia and the Pacific (ESAP); and America. The possible influencing determinants of the convergence/divergence clubs for the regions were also investigated by utilising multinomial logit regression. The determinants were majorly classified into macroeconomic, socio-economic, and institutional quality variables, which were computed via principal component analysis by using six governance indicators. The results show an absence of panel convergence and a weak speed of convergence for the regions. The final club formation results obtained from the iteration procedure show that 6 clubs (for SSA), 2 (for MENA and ECA), 5 (for ESAP), and 3 (for America) were formed for the regions. The determinants of renewable energy consumption play both significant and insignificant roles in the likelihood of a country belonging to a particular convergence club in each of the regions. This study found that at the regional level, the process of convergence in renewable energy consumption is yet to echo desirable emanations of renewable energy consumption policies sharing similar characteristics, but the narrative differs when clustering algorithms form clubs for each region. This implies that at regional levels, achieving convergence clubs in renewable energy consumption for environmental sustainability is possible, most especially when realistic policies around macroeconomic, socio-economic and institutional quality variables are taken into account.

Does trade openness mitigate the environmental degradation in South Africa?

The debate over the role international trade plays in determining environmental outcomes has considerably generated more heat than light. Theoretical work has been successful in identifying a series of hypotheses linking openness to trade and environmental quality, but the empirical verification of these hypotheses has seriously lagged. This study revisits the dynamic relationship between trade openness and environmental quality in South Africa using time series data over the period 1960-2020. The recently developed novel dynamic autoregressive distributed lag (ARDL) simulation framework has been used. The outcomes of the analysis indicate that (i) trade openness deteriorates environmental quality in the long run, although it is environmentally friendly in the short run; (ii) the scale effect increases CO2 emissions, whereas the technique effect contributes to lower it, thus validating the presence of an environmental Kuznets curve (EKC) hypothesis; (iii) energy consumption, foreign direct investment, and industrial value-added contribute to environmental deterioration; (iv) technological innovation improves environmental quality; (v) the pollution haven hypothesis (PHH) exists; and (vi) InSE, InTE, InOPEN, InEC, InFDI, InTECH, and InIGDP Granger-cause InCO2 in the medium, long, and short run suggesting that these variables are important to influence CO2 emissions. In light of our empirical evidence, this paper suggests that the international teamwork to lessen carbon emissions is immensely critical to solve the growing trans-boundary environmental decay and other associated spillover consequences.

What lessons can Africa learn from the social determinants of COVID-19 spread, to better prepare for the current and future pandemics in the continent?

This paper examines the determinants of the spread of coronavirus disease 2019 (COVID-19) in Africa, based on the framework of social determinants of health. Applying Poisson Pseudo Maximum Likelihood (PPML) and quantile regressions to panel data and country-specific socioeconomic background data from 53 African countries, the study finds that enhancing capacity for early testing helps for timeous uncovering of cases, early isolation and contact tracing for effective control of the spread. Other factors such as managing of international movements through reduction of international exposure and ensuring better sanitation and hygiene were found to be relevant in diminishing COVID-19 spread, whereas alcohol consumption and population density heighten the spread. The work also highlights that stringent measures will be counter-productive unless they are coupled with measures to create and preserve livelihoods, together with humanitarian relief assistance to the poorest segments of the population. The results are robust to alternative techniques. As policy recommendations, we implore African governments to the promotion of sustainable livelihoods and social safety nets as measures to accompany stringent lockdowns; and good sanitation programmes to become a lifestyle of citizens. Careful attention should be paid to the socioeconomic trade-off in respect of international travel restrictions given the high dependence of most African economies on tourism.

Socio-economic determinants of global COVID-19 mortalities: policy lessons for current and future pandemics.

This paper examines the different socio-economic determinants of the fatalities associated with the COVID-19 pandemic globally in social determinants of health frameworks. It adapts the Poisson pseudo-maximum-likelihood (PPML) and the quantile regression techniques to effectively exploit the non-linear estimates of the data in order to derive non-biased point estimates at each quantile and make interquantile comparisons. This is particularly useful in recommending which societal variables become most significant at catastrophic levels of a pandemic like COVID-19 when existing health systems become overwhelmed. These estimators are applied to panel data for 196 countries over days of infection from the first recorded case. The COVID-19-related data is from Our World in Data, and the socio-economic variables are from the World Bank's World Development Indicators. The results establish that an improved adequate health infrastructure for both testing and treatment is necessary, but not sufficient. Health systems ultimately become overwhelmed and ineffective in managing cases and reducing mortality in the face of the rising pandemic. Complementary social, economic, physical and environmental factors are necessary for curbing deaths. These factors relate to improving the health stock of the population through reductions in both communicable and non-communicable comorbidities; enhancing sanitation and hygiene; and improving the nutrition of the population. Socio-economic and environmental measures are the reduction of household and ambient air pollution; reduction of exposure to alcohol and cigarettes; reduction of poverty and ensuring economic inclusion; and learning from the past to fine-tune governments' control measures in order to minimize harm to the population while effectively curbing mortality.

The effects of inequality on total factor productivity across districts in South Africa: a spatial econometric analysis.

This study builds on the fundamentals of the new economic geography and the skill-biased technological change argument, to empirically investigate whether increasing income/earning inequality enhances total factor productivity in South Africa. In so doing, panel data of district-municipalities and spatial econometric techniques are used for the period between 1995 and 2015, to gain a better understanding of the role of location and distance in the effects of income inequality on total factor productivity. The results from the analysis and empirical estimations indicate that: (1) there is strong support for the existence of positive spatial interactions in the effects of income inequality on total factor productivity; (2) the estimated direct effect of income inequality on TFP in local district-municipalities is negative and statistically significant, while the indirect effect is positive and statistically significant as well. These findings suggest that district-municipalities with moderate levels of inequality and high economic opportunities, attract more businesses, investments and important stocks of skilled labour from district-municipalities with high inequality. Furthermore, the finding of negative effects supports previous research suggesting that high levels of inequality set the stage for the adoption of distortionary policies which adversely influence the investment climate and produce political instability, thereby stifling the level of productivity and growth.

Revisiting trade and environment nexus in South Africa: fresh evidence from new measure.

The paper revisits the dynamic effect of trade openness on environmental quality in South Africa by employing a fresh proxy of trade openness suggested by Squalli and Wilson (The World Economy 34:1745-1770, 2011) over the period 1960-2016. Contrary to the previous literature, the new proxy is constructed to take into consideration both South Africa's trade share of its GDP and its relative size of trade in relation to the world trade in a specified period of time. Adopting this novel approach to capture openness, the study applies the autoregressive distributed lag (ARDL) bounds test for cointegration approach to investigate the long-run association between trade openness and environmental quality. Our findings show that the results of the long run are materially different from those of the short run. While trade openness has a significantly beneficial impact on CO2 emissions in the short run, it has a measurably detrimental consequence on it in the long run. These findings are new to the literature and contrast with the previous studies. While confirming the existence of an inverted U-shaped curve that validates the existence of environmental Kuznets curve (EKC) hypothesis for South Africa, our results are further supported by the non-linear ARDL model, which reveals evidence of asymmetric pass-through effects of changes in trade openness on CO2 emissions. This paper suggests that South Africa's policymakers must continue to improve trade policy reform with complementary policies to create a less carbon-intensive environment and promote lasting value for reductions of greenhouse gas (GHG) emissions and constantly support the establishment of greener technologies that ultimately lower CO2 emissions.