COMPARATIVE ANALYSIS OF PUBLIC HEALTH EXPENDITURE AND POST-NEONATAL MORTALITY: A CROSS-INCOME GROUP STUDY IN SELECTED SUB-SAHARAN AFRICAN COUNTRIES

Abstract

Sub-Saharan Africa (SSA) continues grappling with disproportionately high post-neonatal mortality despite economic progress. With competing budget priorities, increasing health expenditures' value for accelerating reductions remains contested yet understudied specifically for post-neonatal child health. This analysis aimed to fill this gap by investigating public health spending's impact on post-neonatal mortality stratified by country income levels. Applying the Health Expenditure-Outcome framework, the study analyzed recent panel data across 15 SSA countries, categorized into low, lower-middle and high & upper-middle income groups. Poisson regression modeled country-specific post-neonatal mortality rates as a function of public health expenditure, adjusting for economic, institutional, social and environmental confounders. The study’s descriptive analysis showed stark disparities in post-neonatal deaths, health spending, and related correlates across poorer vs wealthier SSA countries. The Poisson models demonstrated significant mortality reduction per extra unit of public health expenditure across all income categories. However, the mortality lowering effects were substantially greater in higher resourced health systems.  The study thus concludes that public financing for health significantly curtails post-neonatal deaths regardless of economic development levels. Yet returns on investment increase considerably as health systems strengthen over time in transitioning income groups. Sustaining long-term increases in health budgets, prioritizing women and child programs, could accelerate progress. As such, SSA finance/health ministries should develop incremental roadmaps raising budget allocations aligned with Abuja targets given high returns. Improving spending efficiency through governance reforms and integrated investments tackling socioeconomic mortality drivers can further maximize gains