Effectiveness of public health spending: Investigating the moderating role of governance using partial least squares structural equation modelling (PLS-SEM).

BACKGROUND: The link between public health spending (PHS) and population health outcomes (PHO) has been extensively studied. However, in sub-Saharan Africa (SSA), the moderating effects of governance in this relationship are little known. Furthermore, studies have focused on mortality as the main health outcome. This study contributes to this literature by investigating the moderating role of governance in the relationship by simultaneously assessing three dimensions of governance (corruption control, government effectiveness and voice accountability) using disability-adjusted life years (DALYs) as a measure of outcomes. METHODS: The study applies the two-stage moderation approach using partial least squares structural equation modelling (PLS-SEM) to panel data from 43 SSA nations from 2013 to 2019. The study also uses domestic general government health expenditure (DGGHE) as an independent variable and disability-adjusted life years (DALY) as the dependent variable in this relationship. RESULTS: The analysis reveals that DGGHE affects DALY negatively and that governance improves the effect of DGGHE on DALY, with bigger improvements among countries with worse governance. CONCLUSION: These findings provide evidence that good governance is crucial to the effectiveness of PHS in SSA nations. Sub-Saharan Africa (SSA) countries should improve governance to improve population health.

Public health spending in Sub-Saharan Africa: exploring transmission mechanisms using the latent growth curve mediation model.

In response to the imperatives of universal health coverage, structural factors that may hinder the effectiveness of increased spending in sub-Saharan Africa (SSA) need attention. This study assessed the mediating role of these factors in domestic general government health expenditure (DGGHE) effects to propose solutions for improving population health outcomes (PHO). The analysis used the Latent Growth Curve Mediation Model (LGCMM) approach within the structural equation model (SEM) framework for panel data from 42 SSA countries from 2015 to 2018. The findings were that malaria and female education formed a channel through which DGGHE imparted its effects on DALY in SSA, and these effects were achieved via the specific path from the DGGHE slope to the DALY slope, via malaria and female education slopes. However, the paper found no evidence of immunization coverage mediating the relationship between DGGHE and DALY in SSA. The paper concludes that structural factors affect the effectiveness of DGGHE on PHO, implying that governments should emphasize existing programs to fight against malaria and increase immunization coverage.