Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 19;14(1):14.
doi: 10.1186/s13561-023-00472-5.

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

Wa Ntita Serge Kabongo  1 , Josue Mbonigaba  2
Affiliations

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

Wa Ntita Serge Kabongo et al. Health Econ Rev. .

Abstract

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.

Keywords: Latent growth curve mediation; Public health spending; Sub-Saharan Africa.

PubMed Disclaimer

Conflict of interest statement

Authors declare that there is no conflict of interest in this submission.

Figures

Fig. 1
Fig. 1
Study framework Note. This study framework was developed based on Health Field Model. Adapted from "Producing health, consuming health care", by Evans, R.G. and Stoddart, G.L., 2010, Soc Sci Med, 31(12), 1347–63, available: http://dx.doi.org/10.1016/0277-9536(90)90074-3
Fig. 2
Fig. 2
Latent linear growth model Note. X1 to X4 represent observed data collected over four periods, t = 1, 2, 3, and 4; E1 to E4 are time-specific errors. The simple arrows depict the link between the intercept and slope of the observed variables. Double arrows depict the link between growth factors (intercept and slope). Arrows indicate the intercept loading parameters
Fig. 3
Fig. 3
Main Model Mediation Pathways Note. Only the pathways with statistically significant paths are displayed. Covariates (GDP and HIV/AIDS) and factor loadings are omitted for simplicity. Green lines present mediation pathway and the blue line presents the direct effect path. Source: Author's computed using the study dataset and MPLUS 8.10 software
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Abbas F, Hiemenz U. What determines public health expenditures in Pakistan? Role of income, urbanization and unemployment. Economic Change and Restructuring. 2013;46:341–362. doi: 10.1007/s10644-012-9130-7. - DOI
    1. Aiken LS, West SG, Reno RR. Multiple regression: Testing and interpreting interactions, sage. 1991.
    1. Akazili J, Aikins M, Binka FN. Malaria treatment in Northern Ghana: What is the treatment cost per case to households? Afr J Health Sci. 2007;14(1):70–79.
    1. Akinlo AE, Sulola AO. Health care expenditure and infant mortality in sub-Saharan Africa. Journal of Policy Modeling. 2019;41(1):168–178. doi: 10.1016/j.jpolmod.2018.09.001. - DOI
    1. Amwonya D, Kigosa N, Kizza J. Female education and maternal health care utilization: evidence from Uganda. Reprod Health. 2022;19(1):1–18. doi: 10.1186/s12978-022-01432-8. - DOI - PMC - PubMed