Advertisement

An Assessment of Domestic Financing for Reproductive, Maternal, Neonatal and Child Health in Sub-Saharan Africa: Potential Gains and Fiscal Space

  • Chris Atim
  • Eric Arthur
  • Daniel Malik Achala
  • Jacob NovignonEmail author
Original Research Article

Abstract

Background

Reproductive, maternal, neonatal and child health (RMNCH) remains an important public health objective. In sub-Saharan Africa (SSA), inadequate financial commitment continues to pose a major challenge to improving RMNCH outcomes. Understanding financing gains and potential fiscal space for RMNCH can therefore not be overemphasized.

Objective

This study sought to analyse the potential gains from increased domestic financing as a source for improving RMNCH outcomes in SSA. We also assessed, in addition to the potential gains, the potential fiscal space available for financing RMNCH in SSA.

Methods

Our study used panel econometric techniques to estimate gains from increased health financing in terms of RMNCH. We also reviewed tax system performance as well as debt sustainability to identify fiscal space potentials across countries.

Results

We found significant gains from both domestic and external financing. The estimated elasticities suggest that the gains from domestic public financing were much stronger. The fiscal space options identified include tax revenue performance improvements, improved public financial management, and borrowing, at least in the short to medium term. The results show that fiscal space from improved tax systems ranged from US$34.6 per capita in Uganda to US$310.6 per capita in Nigeria.

Conclusion

This result reinforces calls for increased domestic financing for health through innovations in domestic resource mobilization. Improving the performance of tax systems will be a step in the right direction, with possible long-term gains to the health sector.

Notes

Acknowledgements

The authors are grateful to Atakorah Yaw Boateng and Richard Ofori Boateng for the research support they provided. They also acknowledge the administrative and secretariat support received from the office of the African Health Economics and Policy Association (AfHEA).

Author Contributions

CA and JN conceived the study and supervised the analysis; JN, EA and DMA undertook the analysis; and CA, JN, EA and DMA prepared the manuscript. All authors read and approved the final version submitted for publication.

Compliance with Ethical Standards

Funding

The authors received funding from the African Economic Research Consortium (AERC) (Grant no. RC17505) to support this study.

Conflict of interest

Chris Atim, Eric Arthur, Daniel Malik Achala and Jacob Novignon, declare they have no conflicts of interest to report.

References

  1. 1.
    World Bank Group. World development indicators. Washington, DC: World Bank Group; 2017.Google Scholar
  2. 2.
    World Health Organization. World health statistics. Geneva: World Health Organization; 2015.Google Scholar
  3. 3.
    United Nations. The sustainable development goals. New York: United Nations; 2015.CrossRefGoogle Scholar
  4. 4.
    United Nations. The millennium development goals. New York: United Nations; 2015.CrossRefGoogle Scholar
  5. 5.
    The Global Financing Facility 2016-2017 Annual Report. Country-Powered Investments for Every Woman, Every Child. Washington, DC: International Bank for Reconstruction and Development/The World Bank; 2017.Google Scholar
  6. 6.
    Musango L, Ota M. The critical role of health financing in progressing universal health coverage. Afr Monit. 2015;20:3–9.Google Scholar
  7. 7.
    World Bank. Domestic resource mobilization. Washington, DC: World Bank; 2016.Google Scholar
  8. 8.
    European Commission. Domestic revenue mobilisation (DRM). International Developmemt Cooperation; 2018.Google Scholar
  9. 9.
    Williamson RC. Foreign aid and human development: the impact of foreign aid to the health sector. South Econ J. 2008;75(1):188–207.Google Scholar
  10. 10.
    Mishra P, Newhouse D. Does health aid matter? J Health Econ. 2009;28:855–72.CrossRefGoogle Scholar
  11. 11.
    Alemayehu W. Aid and the African Dilemma: the effect of foreign aid on human development in Africa [thesis]. Washington, DC: Faculty of the Graduate School of Arts and Sciences, Georgetown University; 2011.Google Scholar
  12. 12.
    Powell-Johnson T, Borghi J, Mueller D, Patouillard E, Mills A. Countdown to 2015: tracking donor assistance to maternal, newborn, and child health. Lancet. 2006;368(9541):1077–87.CrossRefGoogle Scholar
  13. 13.
    Shpak S. Effectiveness of foreign aid to health: the case of developing countries [thesis]. Submitted for MA in Economic Analysis, Kyiv: Kyiv School of Economics; 2012.Google Scholar
  14. 14.
    Chauvet L, Gubert F, Mesple-Somps S. Aid, remittances, medical brain drain and child mortality: evidence using inter and intra-country data. J Dev Stud. 2013;49(6):801–18.CrossRefGoogle Scholar
  15. 15.
    Mukherjee D, Kizhakkethalackal ET. Empirics of health aid, education and infant mortality: a semiparametric study. J Appl Econ. 2013;45(22):3137–50.CrossRefGoogle Scholar
  16. 16.
    Feeny S, Ouattara B. The effects of health aid on child health promotion in developing countries: cross-country evidence. J Appl Econ. 2013;45(7):911–9.CrossRefGoogle Scholar
  17. 17.
    Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, et al. Global health 2035: a world converging within a generation. Lancet. 2013;382(9908):1898–955.CrossRefGoogle Scholar
  18. 18.
    Boyle CF, Levin C, Hatefi A, Madriz S, Santos N. Achieving a “grand convergence” in global health: modeling the technical inputs, costs, and impacts from 2016 to 2030. PLoS One. 2015;10(10):e0140092.CrossRefGoogle Scholar
  19. 19.
    Heller PS. The prospects of creating ‘fiscal space’for the health sector. Health Policy Plan. 2006;21(2):75–9.CrossRefGoogle Scholar
  20. 20.
    Okwero P, Tandon A, Sparkes S, Mclaughlin J, Hoogeveen JG. Fiscal space for health in Uganda. World Bank Working Paper No. 186. Washington, DC: World Bank; 2010.Google Scholar
  21. 21.
    Nonvignon J, Aryeetey GC, Novignon J, Kontor K, Almeida S, Wanjala B, CIH. Fiscal implications for health financing in African countries recently graduating from low to lower-middle income status: the case of Ghana and Kenya. Accra: African Health Economics and Policy Association (AfHEA); 2016.Google Scholar
  22. 22.
    Soe-Lin S, Frankel S, Heredia E, Makinen M. Tax reform and resource mobilization for health. Bethesda: Health Finance and Governance Project; 2015.Google Scholar
  23. 23.
    First Universal Health Coverage Financing Forum. Raising Funds for Health: Background Paper. Universal Health Coverage Annual Financing Forum; 2016.Google Scholar
  24. 24.
    International Monetary Fund. Revenue mobilization in developing countries. Washington, DC: International Monetary Fund; 2011.Google Scholar
  25. 25.
    Heller PS. Understanding Fiscal Space. PDP/05/4. Washington, DC: International Monetary Fund; 2005.Google Scholar
  26. 26.
    International Monetary Fund. World revenue longitudinal data. Washington, DC: International Monetary Fund; 2019.Google Scholar
  27. 27.
    International Monetary Fund. World economic outlook. Washington, DC: International Monetary Fund; 2019.Google Scholar
  28. 28.
    Ministry of Health. Health sector holistic assessment of the health sector performance—2015. Accra: Ministry of Health; 2016.Google Scholar
  29. 29.
    Novignon J, Olakojo SA, Nonvignon J. The effects of public and private healthcare expenditure on health status in Sub-Saharan Africa: new evidence from panel data analysis. Health Econ Rev. 2012;2:22.CrossRefGoogle Scholar
  30. 30.
    Lawanson AO. Public sector health care financing and health outcomes in Sub-Sharan African countries. In: Olaniyan O, Lawanson AO, Olubajo O, editors. Economics of health sector governance and financing in Nigeria. Ibadan: Ibadan University; 2012. p. 121–48.Google Scholar
  31. 31.
    Russo G, Bloom G, McCoy D. Universal health coverage, economic slowdown and system resilience: Africa’s policy dilemma. BMJ Glob Health. 2017;2(3):1–4.CrossRefGoogle Scholar
  32. 32.
    Appiah B. Universal health coverage still rare in Africa. Can Med Assoc J. 2012;184(2):E125–6.CrossRefGoogle Scholar
  33. 33.
    Jowett M. Safe motherhood interventions in low-income countries: an economic justification and evidence of cost effectiveness. Health Policy. 2000;53:201–28.CrossRefGoogle Scholar
  34. 34.
    Ensor T, Ronoh J. Effective financing of maternal health services: a review of the literature. Health Policy. 2005;75:49–58.CrossRefGoogle Scholar
  35. 35.
    Adam T, Lim S, Mehta S, Bhutla Z, Fogstad H, Mathai M, et al. Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. BMJ. 2005;331(7525):1107.CrossRefGoogle Scholar
  36. 36.
    Borghi J, Ensor T, Somanathan A, Lissner C, Mills A. Mobilizing financial resources for maternal health. Lancet. 2006;368:1457–65.CrossRefGoogle Scholar
  37. 37.
    Besley T, Persson T. Why do developing countries tax so little? J Econ Perspect. 2014;28(4):99–120.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.African Health Economics and Policy Association (AfHEA)AccraGhana
  2. 2.Department of EconomicsKwame Nkrumah University of Science and TechnologyKumasiGhana

Personalised recommendations