Governance, health expenditure and infant mortality in sub‐Saharan Africa

Abstract

The paper examines the effect of governance and health expenditure on infant mortality with a panel data of 32 sub-Saharan African (SSA) countries from 2000 to 2015. Having accounted for potential endogeneity issues related to maternal choices that are made due to contemporaneous infant mortality, the evidence from system generalized method of moment reveals that health expenditure and governance shows no direct influence on infant mortality. However, the coefficient of the interaction between government effectiveness and health expenditure is significant and shows a negative relationship with infant mortality, implying that the effectiveness of health expenditure may be explained by the administrative capacity of countries in SSA. To validate our model, the result from the sensitivity analysis reveals that health expenditure and its interaction with government effectiveness and political stability/ absence of violence exert a reducing effect on the under-five mortality rate. Therefore, since governance quality is lower in SSA compared to other regions, we recommend that governance should be improved consistently in order to achieve health-related outcomes. The findings further signal the urgent need to formulate policies that directly redress health conditions, rather than through indirect instruments. This focus is critical for the advancement of sustainable development goal 3 in SSA. 1 | INTRODUCTION Sustainable development goal (SDG) 16 places emphasis on "peace, justice, and strong institutions" as essential for the achievement of other SDG goals. The world leaders have embraced the idea that the achievement of the post-2015 development agenda will be illusionary without sustained peace, stability, protection of human rights, and effective governance (World Bank, 2015). The New Partnership for Africa's Development (NEPAD) represents an initiative by African leaders to place the continent on the path of sustainable development with strong commitment to good governance, and the consolidation of peace, security, and stability (Herbert & Gruzd, 2008). This is underpinned by the view that the negative effect of ineffective governance in terms of loss of human lives is unthinkable (Joshi, Hughes, & Sisk, 2015, p. 1). Yet, it is still a contested issue in the literature on the type of institutions or governance system required for sustained and inclusive development in the post-2015 African development agenda (Fosu, 2015, p. 114). Despite the abundant natural resources that can be used to advance human development and quality of life, sub-Saharan Africa (SSA) remains the region with the worst human capital foundations

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