Public Healthcare Provisions and Children's Health Outcomes in sub-Saharan Africa

人力资本在促进经济发展中的重要性已得到广泛认可。健康是人力资本的一个关键部分，因为它补充了影响生产力的教育。实现健康和有生产力的人口的路线图首先密切关注婴儿阶段人口的健康，通常是五岁以下年龄组（世卫组织，2016年）。这是因为出生后的头两年是感知和认知发展所必需的大脑网络发育的关键时期（Walker et al. 2011; Batura et al. 2014）。令人遗憾的是，虽然大多数国家自1990年以来在降低儿童死亡率方面取得了长足进展，但在实现可持续发展目标方面取得的进展却十分渺茫，该目标要求各国通过将新生儿死亡率降至每1 000例活产12例，将5岁以下儿童死亡率降至每1 000例活产25例，消除可预防的婴幼儿死亡。在撒哈拉以南非洲（SSA），大多数国家的新生儿和儿童死亡率都在上升，进展尤其缓慢。虽然有大量证据表明，公共卫生支出在促进撒哈拉以南非洲（SSA）的健康成果方面具有有效性，特别是根据对卫生部门的预算货币拨款记录的证据，但证明非货币性公共卫生保健提供（如营养和免疫、卫生基础设施和女性人口的卫生教育）的好处的证据非常少。由于需要解决非洲儿童的不良健康结果，本研究评估了公共保健服务在改善儿童健康结果方面的有效性，重点关注公共保健服务的四个关键领域，即：(i)货币保健；（ii）营养和免疫；（三）卫生基础设施和（四）女性健康教育，以确定它们对南苏丹地区儿童健康结果的影响。本研究基于一种先进的定量方法，该方法植根于计量经济学模型，用于分析涵盖1990年至2021年48个撒哈拉以南非洲国家的区域面板数据集。意识到即将违反支撑传统面板数据回归方法的假设（例如，池OLS [POLS]，固定效应[FE]和随机效应[RE]），本研究将在系统广义矩量法（GMM-SYS）估计器的框架内采用动态工具变量（IV）面板回归来捕捉儿童健康结果的模式，并解决序列相关性，横截面依赖性，内质性，以及未观察到的国家特异性异质性。内质性的可能性以及未观测到的国家固定效应与误差项之间的相关性强调了这种方法方法，这往往违反正交性假设，同时对传统估计量（FE和RE）的一致性产生怀疑。这项研究将扩展到学术界之外，并有助于在卫生部和国际组织之间传播，如联合国儿童基金会、世卫组织、非洲区域卫生协会（ECSA-HC、南部非洲发展共同体和西非卫生组织），这些组织正在与国家卫生部和利益攸关方合作，推动优质医疗保健并降低非洲儿童死亡率。由于其重点关注与联合国消除可预防婴幼儿死亡的可持续发展目标有关的成就，拟议的研究将揭示与卫生货币支出、基础设施、免疫和营养供应以及女性健康素养相关的政策将如何推动实现撒哈拉以南非洲地区儿童和婴儿的良好健康和福祉的可持续发展目标具体目标。除了其主要目标之外，本研究还将提供有关卫生筹资、卫生预算规划和社区卫生的经济学方面的有用见解

The importance of human capital in promoting economic development is widely acknowledged. Health is a key part of human capital as it complements education in affecting productivity. The roadmap to achieving a healthy and productive population begins with paying close attention to the health of the population at the infant stage, usually the under-five age bracket (WHO, 2016). This is because the first 2 years of life from birth are crucial for the growth of brain networks necessary for the development of perception and cognition (Walker et al. 2011; Batura et al. 2014). Regrettably, while the majority of nations have made strides in lowering child mortality since 1990, progress has been far-fetched in achieving the SDGs goal, which calls for each nation to eliminate preventable infant and young child deaths by lowering neonatal mortality to as low as 12 per 1,000 live births and under-5 mortality to as low as 25 per 1,000 live births. In sub-Saharan Africa (SSA), where newborn and child mortality rates are rising in most countries, progress has been particularly slow.While there is a plethora of evidence on the effectiveness of public health spending in promoting health outcomes in sub-Saharan Africa (SSA), particularly documented on the basis of budgetary monetary allocations to the health sector, evidence of benefits of non-monetary public healthcare provisions such as nutrition and immunisation, health infrastructure and health education for the female population has been grossly scarce. Motivated by the need to address the adverse children's health outcomes in Africa, this study evaluates the effectiveness of public healthcare provisions in engendering improved children's health outcomes, focusing on four key areas of public health care provisions namely, (i) monetary healthcare; (ii) nutrition and immunisation; (iii) health infrastructure, and (iv) female health education, to ascertain their influence on children's health outcomes in SSA.This study is based on an advanced quantitative method rooted in an econometric model to analyse a regional panel dataset covering 48 sub-Saharan African countries from 1990 to 2021. Being aware of the impending violation of the assumptions underpinning traditional panel data regression methods (e.g., Pool OLS [POLS], Fixed Effect [FE] and Random Effect [RE]), the study will employ a dynamic Instrumental Variable (IV) panel regression within the framework of the System Generalised Method of Moments (GMM-SYS) estimator to capture the pattern of children's health outcomes, as well as address the problems of serial correlation, cross-sectional dependence, endogeneity, and unobserved country-specific heterogeneity. This methodological approach is underscored by the likelihood of endogeneity, and the correlation between unobserved country-fixed effects and the error term, which tends to violate the assumption of orthogonality while creating doubt about the consistency of the traditional estimators (FE and RE). This study will extend beyond academia and lend itself to dissemination across ministries of health and international organisations like UNICEF, WHO, African regional health associations (ECSA-HC, Southern Africa Development Community and West African Health Organization), who are working with national ministries of health and stakeholders to drive quality healthcare and reduce child mortality rates in Africa. Owing to its focus on achievements relating to the UN SDGs of eliminating preventable infant and young child deaths, the proposed research will reveal how policies related to health monetary spending, infrastructure, immunisation and nutritional provisions alongside female health literacy will drive the attainment of the SDGs targets of good health and well-being of children and infants in the sub-Saharan African region. Beyond its primary objective, this study will provide useful insights along the economics of health financing, budget planning for health, and community healt