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On the efficiency of public health expenditure in Sub-Saharan Africa: Does corruption and quality of public institutions matter?

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  • Novignon, Jacob

Abstract

Health expenditure in Sub-Saharan Africa (SSA) has improved over the years with several recent efforts to improve resource commitments to the health sector. Health outcomes in the region have, however, seen little improvements over the years. Several reasons, including the efficiency of health expenditure, have been given to justify this mismatch. Studies on health expenditure efficiency have mainly focused on developed regions with little attention to SSA. The objective of the study was, therefore, to examine The effects of corruption and public institution quality on efficiency. The efficiency of health expenditure was also compared across selected SSA countries. Data for the study was sourced from the World Bank's World Development Indicators for 45 countries covering the period 2005 to 2011. The two-stage Data Envelopment Analysis (DEA) was employed for the analysis. The first stage computes efficiency scores while the second stage examines the determinants of efficiency using the Tobit model. Per capita health expenditure was used as input while infant, under-five mortality and crude death rates were used as outputs. The results show that health expenditure efficiency was low with average scores of approximately 0.5. This suggests that there exist significant potential for SSA countries to improve population health outcomes given the level of expenditure. There was significant variation across countries with Cape Verde, Eritrea and Mauritius among the efficient countries while Equatorial Guinea, Sierra Leone and Swaziland were relatively inefficient. High corruption and poor public sector institutions reduced health expenditure efficiency. The findings emphasize the fact that, while increased health spending is necessary, it is also important to ensure efficiency in resource use across SSA countries. This can be achieved by effective monitoring and evaluation programmes that ensure reduced corruption and improved public institutions.

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  • Novignon, Jacob, 2015. "On the efficiency of public health expenditure in Sub-Saharan Africa: Does corruption and quality of public institutions matter?," MPRA Paper 39195, University Library of Munich, Germany.
    • Handle: RePEc:pra:mprapa:39195
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    Cited by:

    1. Narayan Sethi & Saileja Mohanty & Aurolipsa Das & Malayaranjan Sahoo, 2024. "Health Expenditure and Economic Growth Nexus: Empirical Evidence from South Asian Countries," Global Business Review, International Management Institute, vol. 25(2_suppl), pages 229-243, April.
    2. Douanla Tayo Lionel, 2015. "Determinants of Health Spending Efficiency: a Tobit Panel Data Approach Based on DEA Efficiency Scores," Acta Universitatis Danubius. OEconomica, Danubius University of Galati, issue 11(4), pages 56-71, August.
    3. Qiang Li & Lian An & Jing Xu & Mina Baliamoune-Lutz, 2018. "Corruption costs lives: evidence from a cross-country study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(1), pages 153-165, January.
    4. Roni Factor & Minah Kang, 2015. "Corruption and population health outcomes: an analysis of data from 133 countries using structural equation modeling," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 60(6), pages 633-641, September.
    5. Novignon, Jacob & Nonvignon, Justice, 2015. "Fiscal space for health in Sub-Saharan African countries: an efficiency approach," MPRA Paper 63015, University Library of Munich, Germany.
    6. Zhizhong Liu & Qianying Chen & Guangyue Liu & Xu Han, 2022. "Do Deep Regional Trade Agreements Improve Residents’ Health? A Cross-Country Study," IJERPH, MDPI, vol. 19(21), pages 1-16, November.

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    More about this item

    Keywords

    Health expenditure efficiency; Tobit model; DEA; SSA; Corruption; Public institutions;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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