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得到了广泛的认可。健康是人力资本的关键部分，因为它在影响生产力方面与教育相辅相成。实现健康和多产人口的路线图始于密切关注婴儿阶段人口的健康，通常是五岁以下人群(世卫组织，2016)。这是因为从出生开始的头两年对于大脑网络的增长至关重要，而大脑网络是感知和认知发展所必需的(Walker等人。2011年；巴图拉等人。2014年)。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步，但在实现可持续发展目标方面取得的进展是遥不可及的，该目标要求每个国家通过将新生儿死亡率降至每1,000名活产12人，将5岁以下儿童死亡率降至每1,000名活产25人，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正在上升，但进展尤其缓慢。尽管有太多证据表明公共卫生支出在促进撒哈拉以南非洲(SSA)健康成果方面的有效性，特别是根据对卫生部门的预算货币分配来记录，但证明非货币公共卫生服务的好处的证据非常稀少，例如营养和免疫、卫生基础设施和女性人口的卫生教育。出于应对非洲不利儿童健康结果的需要，本研究评估了公共医疗保健条款在改善儿童健康状况方面的有效性，重点放在公共医疗保健条款的四个关键领域，即(I)货币医疗保健；(Ii)营养和免疫；(Iii)健康基础设施，以及(Iv)女性健康教育，以确定它们对SSA儿童健康结果的影响。本研究基于一种植根于计量经济学模型的先进量化方法，分析了从1990年至2021年覆盖48个撒哈拉以南非洲国家的区域小组数据集。意识到支持传统面板数据回归方法的假设即将被违反(例如，Pool OLS[POLS]、固定效应[FE]和随机效应[RE])，该研究将在系统广义矩方法(GMM-SYS)估计的框架内使用动态工具变量(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、横截面相关性、内生性和未观察到的国别异质性的问题。这种方法强调了内生性的可能性，以及未观察到的国家固定效应与误差项之间的相关性，这往往违反正交性的假设，同时使人对传统估计值(FE和RE)的一致性产生怀疑。这项研究将超越学术界，并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)，这些组织正在与各国卫生部和利益攸关方合作，推动高质量的医疗保健，降低非洲的儿童死亡率。由于其重点是与联合国可持续发展目标有关的成就，即消除可预防的婴幼儿死亡，拟议的研究将揭示与卫生货币支出、基础设施、免疫接种和营养供应有关的政策以及女性健康素养如何推动实现撒哈拉以南非洲地区儿童和婴儿良好健康和福祉的可持续发展目标。除了其主要目标之外，这项研究还将提供关于卫生筹资经济学、卫生预算规划和社区卫生的有用见解

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