Health Expenditure, Democracy and Child Mortality in Developing Countries

The main objective of this study is to assess the impact of health expenditure on child mortality in the developing countries with due consideration for democracy. To achieve this, we use the two-stage dynamic panel generalized method of moments. Our sample covers 126 countries over the period 1995-2017. Our main results show that sub- Saharan Africa is the only sub-region where health expenditure is negatively and significantly associated with child mortality. However, when we take into account the ranking of countries by income level, we find that health expenditure has a positive and significant effect on child mortality only in the least developed, low income, and lower-middle-income countries. On the other hand, it is in the countries of Eurasia, North Africa, and Latin America that a significant reduction in the child mortality rate takes place in the presence of democratic institutions; to this must be added the upper-middle-income countries. For example, respect for civil liberties, control of government by a democratically elected parliament, combined with spending on health care, contribute to a significant decrease in child mortality. The results of this study are an important issue for policymakers, providing them with a kind of theoretical and empirical argument presenting health expenditure as a major determinant in public health policy. Thus, in their fight against child mortality, it is in the interest of governments in developing countries to improve not only the quality of their health spending but also, and above all, their institutional framework, especially democratic governance.


Mongbet Zounkifirou, Nkoa Francois, Mongbet Ousseni, Njoumemi Zakariaou*

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