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Impact of health expenditure on child death in africa
- 1. Dependence of health outcome on health expenditure in Africa 1 in 8 child dies before 51 in 8 child dies before 5 in Africa 1 Soheila Abachi November 27, 2014
- 2. Facts Life expectancy linked to economic growth (WHO) 10% increase in life expectancy 0.35% increase in economic hgrowth Poor and rich countries economic growth difference due to health status of members (commission on microeconomics & health)health status of members (commission on microeconomics & health) 10 million <5 death in 2006, 5 million from Africa each min te 21 children < 5 die (UNICEF)each minute 21 children < 5 die (UNICEF) ~ 70% caused by diarrhea, malaria, neonatal infection pneumonia preterm delivery lack of oxygen at birthinfection, pneumonia, preterm delivery, lack of oxygen at birth (UNICEF) 2
- 3. Facts ~ 50% of global <5 death in five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, China H l h $/ / 2001Health care $/person/year 2001 (Commission for Africa, 2004) High‐income countries > US$ 2,000 Africa US$13‐$21 in 2001 To deliver basic treatment & care for major communicable diseases & earl childhood and maternal illnesses in s b Saharandiseases & early childhood and maternal illnesses in sub‐ Saharan Africa expenditure should rise to US$ 38 by 2015 3
- 4. Data Health expenditure measured in PPP int. $ 1995 Per capita total expenditure on health 2005 Per capita total expenditure on health Independent variablesp p 1995 Per capita government expenditure on health 2005 Per capita government expenditure on health Child mortality rates in thousandsChild mortality rates in thousands 2000 Number of under‐five deaths 2010 Number of under‐five deaths 2000 Number of infant deaths 2010 Number of infant deaths 2000 Number of neonatal deaths Dependant variables 2010 Number of neonatal deaths 4
- 5. Data Country Total $ 1995 Government $ 1995 < 5 D2000 Infant D2000 Neonatal D2000 Algeria 164.7 119 24 20 12 Angola 84.2 59.5 143 86 36 Benin 43.1 19.4 41 26 11 Botswana 249.4 130.6 4 3 1 B ki F 29 4 11 4 94 49 20Burkina Faso 29.4 11.4 94 49 20 Burundi 24.3 7.8 40 25 11 Cabo Verde 69.4 55.8 1 1 1 Cameroon 52 12 1 95 58 23Cameroon 52 12.1 95 58 23 Central African Republic 25.2 10.7 24 16 7 Chad 36.6 12.7 76 43 18 Comoros 43 6 27 6 2 1 1Comoros 43.6 27.6 2 1 1 WHO databases, African countries, 45 observations, 10 variables 5
- 6. Biological questions 1. Impact of per capita government or total expenditure on health on neonatal death rates 2. Impact of per capita government & total2. Impact of per capita government & total expenditure on health on infant death rates 3 Impact of per capita government or total3. Impact of per capita government or total expenditure on health on < 5 children death ratesrates 6
- 7. 900 1000 Nigeria 500 600 700 800 Per capita total & government health expenditure 1995 and child mortality rate 2000 PC95TEXH PC95GEXH UFD00 ID00 ND00 Seychelles 200 300 400 500 0 100 Algeria Angola Benin Botswana rkina Faso Burundi abo Verde Cameroon ral African … Chad Comoros Congo te d'Ivoire emocratic … ial Guinea Eritrea Ethiopia Gabon Gambia Ghana Guinea nea‐Bissau Kenya Lesotho Liberia adagascar Malawi Mali Mauritania Mauritius zambique Namibia Niger Nigeria Rwanda Tome and … Senegal Seychelles erra Leone uth Africa Swaziland Togo Uganda d Republic … Zambia Total health <Five Infant Neonatal Bur Ca C Centr Côt De Equatori Guin Ma M Mo Sao T S Sie So S United expenditure 1995 D2000 D2000 D2000 Min $6 1 1 1 M $94 86 53 23 7 Mean $94 86 53 23 Max $629 934 567 245
- 8. Scatter plots of original data 250 300 nds) 2000 500 600 ) 2000 100 150 200 tal deaths (thousan Neonatal death 2000 200 300 400 500 deaths (thousands) Infant death 2000 0 50 0 100 200 300 400 500 600 700 Number of neonat Per capita total expenditure on health (PPP int. $) 1995 0 100 200 0 100 200 300 400 500 600 700 Number of infant d Per capita total expenditure on health (PPP int. $) 1995 Per capita total expenditure on health (PPP int. $) 1995 600 700 800 900 1000 ousands) 2000 Nigeria 200 300 400 500 600 der‐five deaths (tho < 5 death 2000 Seychelles 8 0 100 0 100 200 300 400 500 600 700 Number of und Per capita total expenditure on health (PPP int. $) 1995 Seychelles
- 9. Correlation of per capita expenditure on health & child mortality rate& child mortality rate Negative, Low PC95 PC05 PC95 PC05 g , TEXH TEXH GEXH GEXH UFD00 ‐0.21 ‐0.19 ‐0.20 ‐0.21 UFD10 0 18 0 16 0 18 0 19UFD10 ‐0.18 ‐0.16 ‐0.18 ‐0.19 ID00 ‐0.20 ‐0.19 ‐0.20 ‐0.21 ID10 ‐0 18 ‐0 16 ‐0 17 ‐0 19ID10 0.18 0.16 0.17 0.19 ND00 ‐0.21 ‐0.20 ‐0.20 ‐0.21 ND10 ‐0.18 ‐0.17 ‐0.18 ‐0.19 9
- 10. Transformation Square root Did not help with the normalityDid not help with the normality Log 10 Induced the normality considerably 10
- 11. Q1: Impact of per capita government or total expenditure on health on neonatal death ratesneonatal death rates Adjusted R‐squared p‐value AIC ND10 ~ PC05GEXH + PC05TEXH + PC95GEXH + PC95TEXH 0 2808 0 0016 51 530.2808 0.0016 ‐51.53 ND10 ~ PC05TEXH + PC95TEXH 0 2226 0 0019 ‐49 830.2226 0.0019 49.83 ND10 ~ PC05GEXH + PC05TEXH + PC95GEXH + PC95TEXH + ID10 + UFD10 0.9183 0.0000 ‐147.74 ND10 ~ ID10 0 9192 0 0000 152 640.9192 0.0000 ‐152.64 11
- 12. Q2: Impact of per capita government & total expenditure on health on infant death ratesinfant death rates Adjusted R‐squared p‐value AIC ID10 ~ PC05GEXH + PC05TEXH 0.2438 0.0010 ‐41.53 ID10 ~ PC05GEXH + PC05TEXH + PC95GEXH + PC95TEXH 0.3177 0.0006 ‐44.35 ID10 ~ PC05GEXH + PC05TEXH + PC95GEXH + PC95TEXH + ND10 + UFD10 0.9866 0.0000 ‐219.53 12
- 13. Q3: Impact of per capita government or total expenditure on health on < 5 children death rates< 5 children death rates Adjusted R squared p value AICAdjusted R‐squared p‐value AIC UFD10 ~ PC05GEXH + PC05TEXH + PC95GEXH + PC95TEXH 0.3379 0.0003 ‐41.69 UFD10 ~ PC05GEXH + PC05TEXH + PC95GEXH + PC95TEXH + ID10 + ND10 0.2226 0.0019 ‐49.83 UFD10 ~ PC05GEXH + PC05TEXH + PC95GEXH + PC95TEXH + ID10 + ND10ID10 + ND10 0.9809 0.0000 ‐199.65 UFD10 ~ PC05GEXH + ID10 0.981 0.0000 ‐203.24 13
- 14. Quality of fit of the models Assumptions Normality of error termsy Constant variance of residuals vs. fitted values Independence of error termsIndependence of error terms Influential observations 14
- 15. Significance of the factors in full models p‐values of factors Impact of health expenditure on health outcomes of 2010 ND10 ID10 UFD10 Shapiro‐Wilk normality 0.014 0.019 0.069 PC05GEXH 0 806 0 758 0 669PC05GEXH 0.806 0.758 0.669 PC05TEXH 0.394 0.513 0.425 PC95GEXH 0.097 0.088 0.089PC95GEXH 0.097 0.088 0.089 PC95TEXH 0.696 0.860 0.779 15
- 16. Principal component analysis Correlation matrix Eigenvalues >= to 1 1 2 97pc1: 2.97 pc2: 1.57 Cumulatively account for 68 Cumulatively account for 94.4% of variance 402 16 Comp.1 Comp.4 Comp.7 Comp.10
- 17. Scores plot h ld d h l l d d tChild death rates are positively loaded on 1st comp. Per capita health expenditures are negatively loaded on 2nd comp. Comoros Eritrea Liberia p 02 component Benin Burundi Cabo Verde Central African Republic Chad Congo Democratic Republic of the Congo Gambia Guinea Guinea-Bissau Lesotho MadagascarMauritania Niger Rw anda Sao Tome and Principe Togo -20 dprincipalc Botsw ana Burkina Faso Cameroon Chad Côte d'Ivoire Equatorial Guinea EthiopiaGabon Ghana Kenya Malaw i MaliMauritius Mozambique Namibia g Rw anda Senegal Seychelles Sierra Leone Sw aziland UgandaUnited Republic of TanzaniaZambia -4 2n Algeria Angola Nigeria South Africa 17 -5 0 5 1st principal component
- 19. Future studies Female & parent’s educationFemale & parent s education Income & income equity Access to vaccines & HIVAccess to vaccines & HIV prevalence Access to safe drinking waterg Hunger, sanitation 19