The Interactive Effect of Control of Corruption and Government Health Expenditure on Health Outcomes

Introduction

Scholars (e.g., Hlafa et al., 2019) highlighted that many global economies aim for sustainable economic growth and development, requiring certain variables like good health to support growth and development. Thus, a significant part of human capital is health, which Grossman (2017) classified as a durable capital asset that needs ongoing investment because it deteriorates over time. Since health is essential to achieving the Sustainable Development Goals (SDGs), these investments necessitate mobilising internal and external resources (Ibukun, 2021). However, expenditure on health globally is unequal, with developed and high-income countries investing more than low-income countries, resulting in minimal health insurance and out-of-pocket payments in Africa, which only accounts for about 3% of global health expenditure (Ray & Linden, 2020). To help improve governments' commitment to healthcare spending, African leaders came together in 2001 to make a remarkable commitment to enhancing public health spending on the continent to improve health outcomes. This declaration is now known as the Abuja Declaration. By 2015, the target was to raise public health spending to 15% of the federal budget. Novignon and Lawanson (2017) reported that only six (6) African nations-Rwanda (23%), Liberia (18.9%), Malawi (18.5%), Madagascar (15.5%), Togo (15.4%), and Zambia (16%) have been able to meet this goal with Nigeria, Ghana and South Africa not meeting the target.

Accordingly, some countries still lack significant health spending, leading to poorer health outcomes (Rana et al., 2018) such as infant mortality, under-five mortality, maternal mortality and life expectancy. West Africa's health expenditure varies between 0.1 and 3.8% of GDP from 2001 to 2016, compared to 6.2-7.9% in the European Union. The country has high infant mortality rates, under-five mortality rates, and low life expectancy, resulting in poor health outcomes (Ibukun, 2021). Moreover, improving healthcare investment is crucial for sustainable development. It aligns with the United Nations' goal 3 of Universal Health for all (United Nations, 2020), as demonstrated by the impact of the COVID-19 pandemic on the economy and people's lives (Oladosu et al., 2022). Thus, a healthy workforce is productive, and the quality of health in the economy directly impacts economic activity (Orji et al., 2021).

However, according to the World Bank's Human Capital Index, Sub-Saharan Africa faces significant challenges in human capital development, such as health, with an average level of 0.42, compared to a global value of 0.57. For example, between 1960 and 2020, life expectancy worldwide increased significantly, with men reaching 70.6 years and women reaching 75.1 years. Notably, disparities exist between regions, with Africa having a shorter life expectancy of 58 compared to 75 years for America and Asia, 75 years, and in Europe, 78 years (Bazie et al., 2023).

Given this, some studies (e.g., Lucas Jr, 1988) suggest that public spending on health can potentially enhance the development of human capital. Such studies have enhanced our comprehension of the correlation between public spending and health, but few studies analyse government effectiveness in implementing public policies, particularly in Sub-Saharan African countries with corrupt institutional environments (Bazie et al., 2023). This is because, the health sector is a dynamic system made up of intricate relationships between payers, suppliers, patients, providers, and policymakers (Glynn, 2022). But corruption is a global issue in health care systems and is often characterised the misuse of public office for personal benefit (d’Agostino et al., 2016). It's crucial to remember that “corruption” refers to a wide range of behaviours, including those that are illegal in most nations and others that could be deemed morally dubious. Pervasive corruption can undermine and breed mistrust in the health system (Glynn, 2022).