Impact of public health expenditure on child health outcomes in Tanzania.
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Date
2019
Authors
Byaro, Mwoya
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
This Thesis examined whether public health expenditure had an impact on infant and under-five mortality in Tanzania. Additionally, it examines whether domestic government and donor expenditure on malaria had an impact on under-five malaria specific mortality in Tanzania Mainland. The average public health expenditure (% of GDP) in Tanzania increased from 1.36% in 1995/2000 to 3.21% in 2006/2013. In the same years, the average infant and under-five mortality declined from 89 deaths per 1000 live births to 45 deaths per 1000 live births and 145 deaths per 1000 live births to 67 deaths per 1000 live births respectively. In turn, the average domestic expenditure on malaria control decreased from 33 US $ million in 2004/2007 to 4 US $ million in 2012/2015, while average donor expenditure increased from 29 US $ million in 2004/2007 to 105 US $ million in 2012/2015. Likewise, the average under-five malaria deaths decreased from 9065 deaths in 2004/2007 to 3606 deaths in 2012/2015.Are these remarkable improvements in overall child health outcomes contributed by the increase or decrease of public health spending in Tanzania? Aggregate secondary data information was used with different quantitative methods. Bayesian Markov Chain Monte-Carlo (MCMC) simulation was used to examine the impact of public health expenditure on child health outcomes in Tanzania between 1995 and 2013. Again,
Bayesian MCMC and frequentist correlation analysis were utilized to study the impact of government health expenditure on malaria (domestic and donor) and under-five malaria mortality in Tanzania Mainland using a number of control variables such as real GDP per capita, availability of physicians and nurses and number of Insecticide Treated Nets (ITNs) distributed over 2004 to 2015. Lastly, an aggregate panel data technique was used to find out determinant factors for infant and under-five mortality differentials in Tanzanian zone using data from Tanzania Demographic and Health Survey of 1992, 1996, 2004 and 2010. The dependent variables used in the Thesis are infant mortality, under-five mortality and malaria specific under-five mortality. Explanatory variables were chosen guided by the reviewed literature and availability of data. There is no evidence to suggest that, public health expenditure had an impact on infant and under-five mortality in Tanzania between 1995 and 2013 despite various efforts shown by the government on increasing public health budget. Moreover, there is no evidence to suggest that domestic and donor expenditure on malaria had an impact on malaria specific under-five mortality between 2004 and 2015. The failure might be attributed to factors such as misuse of public health expenditure and inadequate funds (health budget less than 15% of National budget) to finance the whole health system in the country. In turn, there is no evidence to suggest that Insecticide Treated Nets (ITNs) had an impact in reducing under-five malaria mortality between 2004 and 2015. Overall, the results show that improvement in child health outcomes in Tanzania was contributed by income (real GDP per capita), availability of nurses and physicians, antenatal care; skilled birth attendant’s (nurses, doctors, midwives), immunization coverage (vaccine measles), ever breastfeeding and maternal education. Combining results from study objectives lead to policy implications that, public health expenditure or public health expenditure resources on malaria (domestic and donor) might be poorly targeted to bring gains in child health outcomes in Tanzania. Thus, it should be channeled towards improving the investments in human resources infrastructures (education and health personnel) as a strategy to improve child health outcomes. In addition, public health expenditure could be diverted towards strengthening specific interventions and programs related to child care than raising overall public health spending. Policy makers in Tanzania should focus either within public health spending composition or beyond to other close determinants of child health outcomes. The Thesis recommends increasing the supply of physicians and nurses, boost/increase economy (real GDP per capita), expanding schools and educating more women in primary, secondary or higher levels to progress reducing infant and under-five mortality. There is need to expand and strengthen stronger health system in access to health care services including immunizations coverage, skilled birth attendants and antenatal care in the country to avoid health
inequity within the country to achieve Sustainable Development Goals.
Description
Thesis of Doctor of Philosophy in Health Economics.