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Government health expenditure Governmenthealth
and child health: empirical expenditure
evidence from West
African countries
Bismark Osei Received 18 April 2022
Department of Economics, University of Ghana, Accra, Ghana Revised 10 December 20229 March 2023
Evans Kulu 27 May 2023
Accepted 8 September 2023
Department of Industrial Mathematics,
C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana, and
Paul Appiah-Konadu
Department of Law, University of Brescia, Brescia, Italy
Abstract
Purpose – The purpose of this paper is to study the effect of government health expenditure on the health of
children (under-five mortality rate and prevalence rate of stunting) among West African countries.
Design/methodology/approach –The studyutilizes heterogeneous panel fromthe period1990 to 2018among
16West African countries for the analysis. The effect of government health expenditure on under-five mortality
rate is measured in per 1,000 live births while that of stunting is measured in percentage. The study employs
Pooled Mean Group (PMG) estimation technique and Impulse Response Functions (IRFs) for the analysis.
Findings – The results indicate that government health expenditure has negative effect on under-five
mortality rate and prevalence rate of stunting in the long-run but not significant in the short-run. In addition,
the IRFs result indicates that under-fivemortality rate and prevalence rate of stunting both respond negatively
to shocks in government health expenditure.
Practical implications – Governments should ensure that inefficiencies in the public health sector are
reduced by licensing the health workers of this sector and allowing independent bodies to appoint the heads of
health institutions. This will improve the delivering of health services for the health of children.
Originality/value – Previous studies carried out have not examined the short-run and long-run effects of the
relationship under study among West African countries.
Peer review – The peer review history for this article is available at: https://publons.com/publon/10.1108/
IJSE-03-2022-0212
Keywords Government health expenditure, Under-five mortality rate, Prevalence rate of stunting,
Effectiveness of governance, GDP per capita
Paper type Research paper
Introduction
The health of children is paramount to every country overall the world. Governments commit
resources to the health sector, some of these resources are channelled towards improving the
health of children (Adeosun and Faboya, 2020; Bingjie and Ronald, 2013; Issa and Ouattara,
2012). That is reducing mortality, morbidity and stunting among children. The magnitude of
governments’ health expenditure tends to differ among countries and continents.
While some governments commit more resources towards financing the health sector,
other governments commit less resources towards the health sector (Hammers and Spears,
International Journal of Social
Open data statement: In the interest of transparency, data sharing and reproducibility, the author(s) of Economics
this article have made the data underlying their research openly available. It can be accessed by © Emerald Publishing Limited
0306-8293
following the link here: 10.6084/m9.figshare.21706922. DOI 10.1108/IJSE-03-2022-0212
IJSE 2016; Byaro, 2021). For instance, statistics from OECD countries indicate that government
health expenditure per capita in 2000 was US$2,338, this increased to US$5,431 in 2018
(Organization Economic Corporation and Development, 2018). Governments in Latin
American Countries (LAC) were not able to commit more resources to the health sector.
As their health expenditure per capita was US$1,235 in 2018 when compared with OECD
countries (Organization Economic Corporation and Development, 2018). LAC countries
performed relatively better when compared with Sub-Saharan African (SSA) countries.
Governments among SSA countries’ health expenditure per capita in 2000 stood at US$79
while in 2018 it was US$243 (World Bank, 2018).
For West African countries, government health expenditure per capita in 2000 stood at
US$47.82 while in 2018 it was US$196.2 (World Bank, 2018). These statistics show that,
governments among West African countries have increased their health expenditure per
capita by 311.58% over the period 2000 to 2018 (World Bank, 2018). Nonetheless, this
performance is relatively low when compared with LAC and OECD countries. Governments
in West African countries showing commitment towards financing the health sector, while
addressing inefficiencies andmisallocation of these resources is relevant (Baldacci et al., 2004;
Ashiabi et al., 2016; Jeffery and Jeffery, 2010). It is expected that these resources will be
channelled towards providing adequate quality health equipments, provision of medical
drugs, constructing hospitals and others. When these resources are well operationalized, it is
expected to improve citizens’ health especially the health of children.
With the health of children, mortality rate and the prevalence rate of stunting have
imposed challenges to children among West African countries (Bingjie and Ronald, 2013;
Alexiou and Trachanas, 2021; Novignon et al., 2012). In 2018, statistics among West African
countries show that, the mortality rate of children under five years was 127.4 per 1,000 live
births while the prevalence rate of stunting was 34.24% (World Health Organization, 2018).
Has the increase in government health expenditure produced any short-run and long-run
effect towards reducing under-five mortality rate and prevalence rate of stunting among
these 16 West African countries? In 2012, research conducted by Africa Health Research
Institute (2012) identified that, government health expenditure tends to have more long-run
effect on the health of South Africans than short-run effect.
Does this result holds for West African countries calls for a thorough investigation into
this issue? Hence, this study seeks to fill the yawning gap in existing empirical studies by
examining the short-run and long-run effects of government health expenditure on the health
of children among West African countries. It is important to investigate this issue because
this will guide policymakers to implement the right strategies in order to ensure that,
government health expenditures produce good results both in the short-run and long-run on
the health of children. The outcome of the study is also relevant to governments and other
stakeholders towards fine-tuning of policies’ frameworks to make the needed contributions
towards improving the health of children among West African countries.
Literature review
This section reviews Wagner’s theory of public expenditure and the relevant empirical
studies to help deepen our understanding on the subject matter.
Theoretical review
Wagner’s theory of public expenditure developed by Adolph Wagner in 1883 was reviewed
for the study. The theory postulates the extent to which governments work towards
increasing their public expenditures in diverse aspects of the economywith respect to sectors
such as: health, employment, education, housing facilities and others. The intention behind
this laudable development is to work towards improving the standard of living of the Government
citizenry which covers adults and children. The theory predicts that the development of health
countries depends heavily on governments’ ability to commit the needed public expenditure expenditure
to propel the needed growth in economic activities. Wagner (1883) stated that, governments
in their attempt to achieve that, should ensure that there is a long-run tendency for the share
of public expenditure to increase relative to national income. The theory predicts the extent to
which governments should make effective public expenditure in ever-increasing social
services for the citizenry. It further stated that, governments’ inability to make the required
public expenditure will mount increasing political pressure on governments.
This theory is relevant for the study because it emphasizes on the need for governments
among West African countries to increase their public expenditures on social services
especially in the health sector. This should contribute significantly towards improving the
health of the citizenry especially children.
The central tenet of the theory supports Abuja Declaration for health which entreats
governments among African countries to commit 15% of their annual budgets towards
financing the health sector to improve the health of the citizenry especially that of children
(African Union, 2001). Despite the slow growth in their economies relative to developed
countries, these governments have no option but instead to keep on increasing their
investment in the health sector. Especially, with respect to the health of children where the
issue of under-fivemortality rate (for diseases such asmalaria, diarrhoea, measles, diphtheria
and others) and prevalence rate of stunting should be properly tackled with these
government expenditures on the health sector towards achieving this objective.
Empirical review
Numerous empirical studies have been carried out examining the effect of health expenditure
on the health of children.
Empirical studies carried out by Ashiabi et al. (2016) and Akinlo and Sulola (2018)
examined the subject matter focusing on SSA countries. In the case of Ashiabi et al. (2016)
examined how government health expenditure and private health expenditure affect
maternal and child health among SSA countries. Comparing this with that of Akinlo and
Sulola (2018), Akinlo and Sulola (2018) rather examined how government health expenditure
affects the health of children among SSA countries. This means that, the study carried out by
Akinlo and Sulola (2018) did not consider the aspect of private health expenditure and
maternal health in their analysis as done in the case of Ashiabi et al. (2016). Results from the
study of Ashiabi et al. (2016) indicated that, public health expenditure has reduced infant and
under-five mortality rates among SSA countries. With respect to private health expenditure,
it did not have any significant effect on under-five, infant andmaternal mortality rates among
these countries. In the case of Akinlo and Sulola (2018), the result indicated that health
expenditure by government has increased infant mortality rate.
The results of these empirical studies imply that governments among SSA countries
should work towards increasing their health expenditures to improve the health of both
mothers and children. As a matter of fact, a lot of efforts will be required on the part of these
governments towards achieving that. Indeed, this will be possible when public health sector
inefficiencies are dealt with. The issue of the important role of the private health sector was
also articulated, hence the necessary measures have to be operationalized towards helping
private health sector to play such an important role.
Empirical studies carried out by Olufemi et al. (2019) and Adeosun and Faboya (2020)
examined the subject matter focusing on countries in West Africa. Olufemi et al. (2019)
examined the relationship between public health expenditure and under-five mortality rate
among West African countries. The study employed panel Fully Modified Least Square
IJSE (FMOLS) method and data covering the period 1991 to 2015 for the analysis. Comparing this
with that of Adeosun and Faboya (2020), Adeosun and Faboya (2020) rather examined the
effect of healthcare expenditure on child mortality by focusing on Nigeria.
Child mortality was measured by under-five mortality and neonatal mortality rates. The
study employed time-series data covering the period 1986 to 2016 and Vector Autoregressive
(VAR) model for the analysis. Comparing the two empirical studies, Olufemi et al. (2019)
covered broader scope of study of 16 countries but only concentrated on under-five mortality
rate as a measure for child health. The study of Adeosun and Faboya (2020) even though
concentrated on one country (Nigeria), its measurement of child health was broader, that is
the use of under-five mortality and neonatal mortality rates. Results from the study of
Olufemi et al. (2019) indicated negative relationship between public health expenditure and
under-five mortality rate. In the case of Adeosun and Faboya (2020), the result indicated that
healthcare expenditure has reduced under-five mortality and neonatal mortality rates in
Nigeria.
Results of these studies imply that, one specific aspect of child health these governments
amongWest African countries should focus on is addressing the issue of under-fivemortality
and neonatal mortality rates. Information gathered from World Health Organization (WHO)
indicates that, under-five mortality and neonatal mortality rates are among the leading cause
of health problems among children in Africa. Hence, these governments have to
operationalize expenditure rationalization towards making enough revenue available to
achieve this objective.
These empirical studies and others (Novignon et al., 2012; Issa and Ouattara, 2012; Bingjie
and Ronald, 2013; Musonda and Byaro, 2016; Hammers and Spears, 2016; Byaro, 2017;
Barenberg et al., 2017; Abeka-Nkrumah et al., 2021) even though focused on examining the
effect of health expenditure on health outcomes of children. The issue of how government
health expenditure effect on child health differs comparing the short-run and long-run
outcomeswas not identified by these studies. Hence, this study contributes towards filling the
yawning gap in existing empirical studies by examining the extent to which government
health expenditure affects the health of children both in the short-run and long-run.
Carrying out this study is important because it will guide policymakers the right
strategies to implement to ensure that, government health expenditure produces higher effect
on child health both in the short-run and long-run. The outcome of the study is also relevant to
governments and other stakeholders towards fine-tuning of policies’ frameworks tomake the
needed contributions towards improving the health of children among West African
countries.
Methodology and data
This section focuses on explaining the model specification and variables used for the
analysis.
Model specification
The study employs Pooled Mean Group (PMG) estimation technique for the analysis. The
model is specified based on the concepts of Wagner’s theory of public expenditure. This
estimation technique is appropriate because the study is dealing with heterogeneous panel
(where the time period is greater than cross sectional units). In examining short-run and long-
run effects with panel data, only models like PMG, Mean Group (MG) and Dynamic Fixed
Effect (DFE) models can be used. These models rely on heterogeneous panel data with long
time period for robust results. Hausman test selected PMG ahead of MG and DFEmodels for
the analysis. The time period in this study is from 1990 to 2018 while the cross-sectional units
is 16. This time period is chosen because over these periods these countries have experienced Government
different health policies, changes in governments and expansion in their economies. These health
have affected their governments’ expenditures on the health sector. This study is interested expenditure
to find out how governments’ commitment towards financing the health sector has affected
the health of children. Again, the estimation technique is appropriate because it provides both
short-run and long-run results. This will guide governments and other stakeholders the right
policies and strategies to implement to achieve good results for the health of children both in
the short-run and long-run.
PMG relies on ARDLmodel for estimation as proposed by Pesaran et al. (1999). Hence, the
general ARDL model as specified by Pesaran et al. (1999) is written as;
Xp X
Yit ¼ q 0¼ λiYi;t j þ δ−j 1 j¼0 ijXi;t j þ αi þ mit (1)−
where Yit is the dependent variable, Xi;t j is a K x 1 vector of variables that are either purely−
Ið0Þ or Ið1Þ or cointegrated; λi is the coefficient of the lagged dependent variable called
scalars; δ0ij are K x 1 coefficient vectors; αi is the unit-specific fixed effects;
i5 1; . . . . . . ;N ; t ¼ 1; 2; . . . . . . . . . :T; p; q are optimal lag orders; mit is the error term.
Re-parameterized ARDL gives Error Correction Model (ECM), the general model as
specified by Pesaran et al. (1999) is written as:
Xp 1 0 X XΔY ¼ f ξ þ − þ q−1 0 q−1λ ΔY δ ΔX þ γ0 X 0it i i;t 1 i;t j i;t j þ αi þ β tþm (2)− − −j¼1 ij j¼0 ij j¼0 ij i;t−1 i it
where ξ 0i;t 1 5 Yi;t 1 −Ө Xit represents the deviation from the long-run equilibrium.− −
Yit is the dependent variable
Xit is the vector of explanatory variables.
mit is the error term whose variance differs across groups.
The coefficient fi is the short-run error correction term that measures the adjustment speed
towards the long-run equilibrium.
δ and γ are the vectors of short-run coefficients and long-run coefficients
αi and βi are country specific effects
Hence, the model for the study is specified as;
Xp 1 X− q−1
ΔCHEALTHt ¼ fiξ 0 0i;t 1 þ− j¼ λ1 ijΔCHEALTHt j þ δ ΔEXP− t−jj¼0 ij
X
þ q−1 0
X
þ q 1 0
X
− þ q−1γ ΔEXP δ 0 0¼ ij t−j ¼ ijΔXi;t γ X−jj 0 j 0 j¼0 ij i;t−1 þ αi þ βitþmit
where ξ ¼ Y Ө0 (3)i;t 1 i;t 1 − Xit represents the deviation from the long-run equilibrium.− −
where CHEALTH is Child Health EXP is Government health expenditure
Yit is the dependent variable (child health is measured by under-five mortality rate and
prevalence rate of stunting under-five). The prevalence rate of stunting is used for
robustness check.
Xit is the vector of explanatory variables (GDP per capita, sanitation services,
effectiveness of governance, female literacy rate, health facility, employment rate).
Variables used for the model
This section explains the variables used for the analysis. All these variables are collected
from World Bank (World Development Indicators) with the exception of effectiveness of
governance that is collected from World Governance Indicators (WGI).
IJSE Dependent variable. Child health is measured by under-five mortality rate and prevalence
rate of stunting (height-to-age ratio for under-five) as done in the study of Olufemi et al. (2019).
Under-five mortality rate refers to the number of children who die before the age of five years
per 1,000 live births. Prevalence rate of stunting refers to the percentage of children who are
under-five years whose height for age is below the median for the international reference
population. Under-five mortality rate is measured in per 1,000 live births and stunting is
measured in percentage. These variables are appropriate for measuring child health because
according to United Nations Children Fund (UNICEF), mortality rate and stunting are among
the health problems that adversely affect the health of children in Africa. Data on children
who are aged 14 years and 18 years was not available, hence the use of these proxies.
Independent variable. Government health expenditure in this study consists of recurrent
and capital spending incurred by government on the health sector, as done in the study of
Ashiabi et al. (2016). The variable is included in the analysis to examine how government
expenditure has contributed towards improving the health of children both in the short-run
and long-run period. The variable is measured in US dollars. The variable is appropriate for
the analysis because governments’ ability to provide the needed: medical drugs, health
facilities, training of health personnel and subsidizing health expenditures, will contribute
towards improving the health of children. Hence, it is expected to have negative effect on
under-five mortality rate and prevalence rate of stunting.
Control variables.GDP per capita refers to gross domestic product of a country divided by
the population. The variable is included in the analysis to examine the extent to which
increase in GDP per capita translates into improving the health of children. The variable is
measured in US dollars. The inclusion of this variable in the analysis is appropriate because
increase in GDP per capita enhances the standard of living of the citizenry. All things being
equal, the increase in GDP per capita will increase parents’ income.
This will help them towards providing for their children the right medication, nutrition
and live in a healthy environment. This will contribute towards improving the health of
children that is reducing both under-five mortality rate and prevalence rate of stunting.
Female literacy rate in this studymeasures the percentage of femaleswho are 15 years and
above who can read and write and are able to understand issues concerning their lives. The
study carried out by Baldacci et al. (2002) used the same variable for analysis. The variable is
included in the analysis because women spend more time with their children than their
fathers. The inclusion of the variable is relevant because when the knowledge of mothers is
enhanced, it helps them to take better health decisions to improve the health of their children.
Hence, female literacy rate is expected to have negative effect on under-fivemortality rate and
prevalence rate of stunting. The variable is measured in percentage.
Effectiveness of governance as used in this studymeasures how the government is able to
produce quality products and implement good policies, as done in the study of Bingjie and
Ronald (2013). The inclusion of the variable is important because governments’ ability to
render quality services contributes positively towards improving the health of children. It is
expected that, governments’ ability to render quality services will help to reduce mortality
rate and prevalence rate of stunting. Hence, the variable is expected to have negative effect on
under-five mortality rate and prevalence rate of stunting. The variable is measured on scale
from 2.5 to 2.5.
Sanitation services refers to percentage of people who have access to sanitation facilities
and they do not share with other households. The study carried out by Checkley et al. (2004)
used the same variable for analysis. The variable is included in the analysis because having
proper sanitation services helps to prevent diseases like malaria, cholera, diarrhoea and
others. This contributes towards improving the health of children. Hence, it is expected to
have negative effect on under-five mortality rate and prevalence rate of stunting. The
variable is measured in percentage.
Health facility as used in this study is proxied by hospital beds, as done in the study of Government
Abeka-Nkrumah et al. (2021). Hospital beds measures inpatient beds which are available in health
public, private, general and specialized hospitals per 1,000 people. The variable is included in expenditure
the analysis because governments’ ability to provide the needed health facilities, helps health
personnels to render better health services to children. This contributes positively towards
improving the health of children. Hence, health facility is expected to have negative effect on
under-five mortality rate and prevalence rate of stunting. It is measured in per 1,000 people.
Employment rate is proxied by employment to population ratio. The study carried out by
Kuhlthau and Perrin (2004) used the same variable for analysis. This refers to the proportion
of the country’s population within the working age who are engage in economic activities.
This variable is included in the analysis because when the individuals are able to secure jobs,
it helps them to afford medical drugs, good healthy meals and live a healthy environment.
These help them to improve their health including their children. Hence, it is expected that
employment rate will have negative effect on under-five mortality rate and prevalence rate of
stunting. The variable is measured in percentage.
Results and discussion
Estimates from descriptive statistics
Estimates from the summary statistics have been presented in Table 1. The under-five
mortality rate has a mean value of 132.10 per 1,000 live births, with a minimum value of 15.8
per 1,000 live births and a maximum value of 329.6 per 1,000 live births. This means that,
there is a wide difference in the under-five mortality rates among these 16 countries.
Concerning the prevalence rate of stunting, the estimates indicate a mean value of 34.67, a
minimum value of 22.13 and a maximum value of 45.3. This means that, there is not so much
wide difference in the prevalence rate of stunting among these countries. Estimates from
government health expenditure per capita indicate amean value of 32.99, aminimumvalue of
10.059 and a maximum value of 225.65. This means that, there is a wide difference in
government health expenditure per capita among these countries.
Correlation and Hausman test
Correlation test is carried out for the explanatory variables in checking for multicollinearity
using the Variance Inflator Factor (VIF). The result as shown in Table 2 indicates no
multicollinearity among the independent variables. According to the results, sanitation
services has the highest VIF of 4.63. According to the rule of thumb, a variable with VIF
higher than 5 is said to be causing multicollinearity in the analysis. Since the VIF of these
Variables Observation Mean Std. dev. Minimum Maximum
Under-five mortality 464 132.10 57.50 15.8 329.6
Prevalence of stunting 464 34.67 4.97 22.13 45.3
Government health expenditure 304 32.99 36.49 10.06 222.65
GDP per capita 454 834.31 680.69 138.70 3740.37
Employment rate 448 61.28 9.75 40.51 72.99
Effectiveness of governance 272 22.71 15.49 2.88 65.05
Female Literacy rate 464 28.79 12.28 8.90 52.99
Health facility 464 0.61 0.27 0.81 1.2
Sanitation services 464 21.43 5.69 13.04 31.89
Note(s): Std. Dev. represents standard deviation Table 1.
Source(s): Authors own creation Descriptive statistics
IJSE variables are less than 5, there is no existence of multicollinearity among the independent
variables. Hausman test as shown in Table 2 indicates a p-value of 0.81. This means that,
PMG is selected for the analysis ahead of the Mean Group (MG) estimator.
Short-run and long-run regression results
Government health expenditure has negative effect on both under-five mortality rate and
prevalence rate of stunting among these countries in the long-run, however the short-run
results are not significant as shown in Tables 3 and 4 respectively. Controlling for these
variables: GDP per capita, employment rate, female literacy rate, health facility, sanitation
services and effectiveness of governance. Put differently, it means that in the long-run
government health expenditure reduces mortality rate of children under five years and
prevalence rate of stunting. These long-run results are consistent with our expectation
and empirical studies results of Barenberg et al. (2017), Bingjie and Ronald (2013), Issa and
Ouattara (2012).
Variables VIF Hausman specification test
Sanitation services 4.63 Prob > χ2 5 0.81
Prevalence of stunting 4.59
Per capita 3.17
Government health expenditure 2.91
Literacy rate 2.56
Health facility j 1.73
Table 2.
Multicollinearity test Effectiveness governance 1.49
(variance inflation Employment rate 1.29
factor) and Hausman Mean VIF 3.37
specification test Source(s): Authors own creation
Under-five mortality rate Coefficients Standard error
Long-run results
Government health expenditure 13.47** 5.87
GDP per capita 0.013** 0.0054
Employment 1.69** 0.90
Effectiveness of governance 0.19 0.26
Female literacy rate 0.49 0.37
Health facility 8.22 10.32
Sanitation services 3.44*** 0.96
Short-run results
Error correction term 0.00056*** 0.0001
Government health expenditure 0.00021 0.00013
GDP per capita 0.0008 0.0055
Employment 0.0013 0.0015
Effectiveness of governance 0.00105* 0.0018
Female literacy rate 0.00017 0.00013
Health facility 0.00164 0.0046
Table 3.
Effect of government Sanitation services 0.0151** 0.018
health expenditure on Constant 0.033 0.041
Note(s): Standard errors in parentheses, *p < 0.05, **p < 0.01, ***under-five p < 0.001
mortality rate Source(s): Authors own creation
Government
Prevalence rate of stunting Coefficients Standard error
health
Long-run results expenditure
Government health expenditure 0.094** 0.32
GDP per capita 0.003 0.004
Employment 0.011 0.059
Effectiveness of governance 0.019 0.017
Female literacy rate 0.24*** 0.024
Health facility 4.32*** 0.68
Sanitation services 1.42*** 0.061
Short-run results
Error correction term 0.052*** 0.0022
Government health expenditure 0.00053 0.0075
GDP per capita 0.000047 0.003
Employment 0.0052 0.089
Effectiveness of governance 0.0018** 0.0010
Female literacy rate 0.0058*** 0.008
Health facility 0.099*** 0.029
Sanitation services  Table 4.0.55*** 0.10 Effect of government
Constant 3.69*** 0.27 health expenditure on
Note(s): Standard errors in parentheses *p < 0.05, **p < 0.01, ***p < 0.001 prevalence of stunting
Source(s): Authors own creation (robustness check)
Examining the composition of government health expenditure among these countries
indicates that, capital health expenditure constitutes 61.8–67% annually on average (World
Bank, 2018). Capital health expenditure tends to have long-run effect on the health of children.
For example, the construction of children’s hospital will take about 2 or more years before the
building will be completed. This means that, the effect of this expenditure towards reducing
under-five mortality rate and prevalence rate of stunting will be stronger in the long-run.
Sincemajority of these health expenditures aremade up of capital health expenditure, it tends
to have long-run effect. In addition, the study identified that, most of these countries’
governments release of funds towards improving the health sector (which includes
improving the health of children) tends to take more time before the money is release due to
inefficiencies in the public health sector. This implies that, the release of government health
expenditure will have a long-term effect towards reducing under-five mortality rate and
prevalence of stunting among these West African countries. These governments have an
important role towards reducing the inefficiencies in the public health sector.
GDP per capita has positive significant effect on under-five mortality rate in the long-run.
Put differently, it means that an increase in per capita income increases under-five mortality
rate in the long-run. The result is not consistent with our expectation and results of these
empirical studies (Anyanwu and Erhijakpor, 2007; Baldacci et al., 2004; Cutler et al., 2006).
The study identified that, these 16West African countries over these years have injected a lot
of efforts towards increasing the productivity of their economic activities to boost their GDP.
Information gathered among these countries over the years indicates that, enhancing
economic activities helps to increase GDP among these countries. However, some of these
economic activities in the area of mining, manufacturing, exploring oil and others end up
polluting the environment.
The pollution of the environment leads to the spread of diseases such as low birth weight,
asthma, lung diseases, respiratory infections and other related diseases that affect the health
of children. The long-run effect tends to be higher due to the increase in economic activities in
IJSE the long-run, hence environmental protection agencies among these countries should work
towards dealing with the problem.
Sanitation services rendered significantly reduce under-five mortality rate both in the
short-run and long-run. These results are consistent with our expectations and empirical
studies carried out by Checkley et al. (2004) andHammers and Spears (2016). Government and
private waste management companies’ ability to provide quality sanitation services and
facilities will help to reduce waste-related diseases like malaria, diarrhoea and others. This
will help to reduce under-five mortality rate. Over the years, waste management companies
have increased with the majority of these companies being private companies. The rendering
of sanitation services by these companies and the public willingness to pay for their services
have led to the increase in these services. Statistics from Water, Sanitation and Hygiene
(WASH) indicate that, over the period the rendering of these sanitation services have
increased by 68.5% from the period 2000 to 2018 (Water, Sanitation and Hygiene WASH,
2018). This had led to reduction in under-fivemortality rate among these countries both in the
short-run and long-run. However, the long-run effect is higher than the short-run effect. This
is because, in the long-run, we expect that waste management companies will expand their
services more by increasing the construction of recycling plants to improve the environment,
hence affecting the health of children positively.
Effectiveness of governance has a negative effect on under-fivemortality rate in the short-
run. Put differently, this means that governments’ ability to implement health policies helps
to reduce under-five mortality rate in the short-run period but not in the long-run period. The
result obtained in the short-run is consistent with our expectations and the empirical study
result of Ashiabi et al. (2016). Over the years, these countries have worked towards the
formulation and implementation of health policies to improve the health of the citizenry
especially children. These policies formulation and implementation were carried out by these
governments with the support of foreign agencies and other stakeholders. These
governments have also showed commitment towards ensuring training of public health
administrators and staff towards improving effectiveness of governance. Inmost countries in
West Africa or even Africa as a whole.
Most at times, there is discontinuity or lack of commitment in implementing government
health policies in the long-run especially when there is a change in government or funds for
the policies run out. This reason accounted for the effectiveness of governance not producing
any long-run effect result.
Employment rate has a positive effect on under-five mortality rate in the long-run. The
result in the long-run means that as employment rate increases, it increases under-five
mortality rate. The result obtained is not consistent with our expectation and empirical
studies carried out by Byaro (2021) and Bingjie and Ronald (2013). Information gathered
amongWest African countries indicates that, most workers are poorly paid especially in their
earlier years of work due to their less working experience. However, in the long-run as they
work formore years their working experience increases and they are able to obtain additional
qualifications. Their work earnings increase, this encourages them to increase their economic
activities in their quest to mass more wealth.
Most of these economic activities (especially those that border on mining, manufacturing,
production of oil, informal sector activities and others) tend to pollute the environment this
has an adverse effect on the health of the citizenry (especially children). Thismeans that in the
long run, the increase in employment will lead to an increase in under-five mortality rate.
Hence, governments and other stakeholders should work towards ensuring that, these
activities should be environmentally friendly to reduce this problem and ensure that these
workers are well paid to deal with this problem towards improving the health of children.
Error correction term value indicates that, deviations from short run will adjust at a speed of
0.058% towards the long-run equilibrium.
Impulse responses functions Government
IRF is a dynamic system which its output provides brief input signal called impulse. Simply health
put, impulse response explains how dynamic system reacts to changes in the system. That is, expenditure
it describes the reaction of a system as a function of the independent variables that
parameterizes the dynamic behaviour of a system. In this study, we are interested in finding
out how child health (that is under-five mortality rate and prevalence rate of stunting)
responses to shocks in government health expenditure. Under-five mortality rate and
prevalence rate of stunting responses to shocks in government health expenditure are
represented in Figure 1 a and b respectively.
The findings from the regression estimations are complemented with this impulse
responses’ results. Thus, responses for under-five mortality rate and prevalence rate of
stunting are verified based on shocks in government health expenditure. It is observed that,
shocks in government health expenditure reduces under-five mortality rate (see Figure 1a) as
well as stunting (see Figure 1b). Figure 1a indicates that, under-five mortality rate increase is
minimal at the initial level and starts reducing after the third period. However, it is found in
Figure 1b that, the prevalence rate of stunting reduces just after the first period when there is
a shock in government health expenditure.
Conclusion and policy implication
Numerous empirical studies have examined the effect of health expenditure on child health.
This study contributes to existing empirical studies by examining the short-run and long-run
effects of government health expenditure on child health amongWest African countries. The
result of the study indicates that government health expenditure has negative effect on
under-five mortality rate and prevalence rate of stunting in the long-run. The impulse
responses results indicate that, under-five mortality rate and prevalence rate of stunting both
respond negatively to shocks in government health expenditure.
The study recommends that, for government health expenditure to produce a higher effect
on the health of children both in the short-run and long-run. There is the need to ensure that
governments among West African countries should commit more expenditure towards
financing the health sector. Governments among these West African countries should
Figure 1.
Impulse response
function (IRF). (a)
Response of under-five
mortality to
government
expenditure shocks, (b)
response of stunting to
government
expenditure shocks
IJSE implement effective strategies towards ensuring that, there is excessive cut in the wastage of
resources in the public health sector.
Africa Development Bank’s (AfDB) report in 2021 stated that, the excessive waste of
resources in the public health sector has increased by 45–56.1% over the past 8 years among
African countries (Africa Development Bank, 2021). An effective measure such as licensing
the health workers of public sector and allowing independent bodies to appoint the heads of
health institutions, will help towards instilling discipline in the public health sector to help
reduce the waste of these resources. These resources can then be channelled towards
increasing government health expenditure on children. In addition, governments should
ensure continuity in the implementation of child health policies. Especially, when there is a
change in governments, this will help to achieve positive effect result.
Studies that can get access to data for long period for example 60 or 83 years should
examine the subject matter for the entire African countries or SSA countries. This study
could not achieve this, due to unavailability of data.
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Corresponding author
Bismark Osei can be contacted at: bismarkosei84@yahoo.com
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