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

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.