School of Accounting, Economics and Finance, University of KwaZulu-Natal, 15 University Road, Westville, 4001, Durban, South Africa.
Health Res Policy Syst. 2024 Jul 8;22(1):80. doi: 10.1186/s12961-024-01159-x.
The link between public health spending (PHS) and population health outcomes (PHO) has been extensively studied. However, in sub-Saharan Africa (SSA), the moderating effects of governance in this relationship are little known. Furthermore, studies have focused on mortality as the main health outcome. This study contributes to this literature by investigating the moderating role of governance in the relationship by simultaneously assessing three dimensions of governance (corruption control, government effectiveness and voice accountability) using disability-adjusted life years (DALYs) as a measure of outcomes.
The study applies the two-stage moderation approach using partial least squares structural equation modelling (PLS-SEM) to panel data from 43 SSA nations from 2013 to 2019. The study also uses domestic general government health expenditure (DGGHE) as an independent variable and disability-adjusted life years (DALY) as the dependent variable in this relationship.
The analysis reveals that DGGHE affects DALY negatively and that governance improves the effect of DGGHE on DALY, with bigger improvements among countries with worse governance.
These findings provide evidence that good governance is crucial to the effectiveness of PHS in SSA nations. Sub-Saharan Africa (SSA) countries should improve governance to improve population health.
公共卫生支出（PHS）与人口健康结果（PHO）之间的关系已经得到了广泛的研究。然而，在撒哈拉以南非洲（SSA），治理在这种关系中的调节作用知之甚少。此外，研究主要集中在死亡率作为主要健康结果上。本研究通过使用残疾调整生命年（DALYs）作为衡量结果的指标，同时评估治理的三个维度（腐败控制、政府效能和声音问责制），在这一文献中做出了贡献。
本研究采用两阶段调节方法，使用偏最小二乘结构方程模型（PLS-SEM）对 2013 年至 2019 年来自 43 个撒哈拉以南非洲国家的面板数据进行分析。本研究还将国内一般政府卫生支出（DGGHE）作为自变量，残疾调整生命年（DALY）作为因变量，用于这种关系中。
分析表明，DGGHE 对 DALY 有负面影响，而治理则改善了 DGGHE 对 DALY 的影响，在治理较差的国家中，这种改善更大。
这些发现提供了证据表明，良好的治理对于撒哈拉以南非洲国家的 PHS 有效性至关重要。撒哈拉以南非洲（SSA）国家应改善治理，以改善人口健康。
