Public health spending and health outcome in Nigeria: the role of governance

Purpose - This paper aims to analyze the relationship between public health spending and health outcome using time series data in Nigeria over the period 1980 to 2017, taking into account the role of governance by assessing how the quality of governance directly affects health status and indirectly as a mediator for the effectiveness of public health spending. Design/methodology/approach - Using the Hausman statistical tests to check for the existence of endogeneity, the proper method for estimating the model for this study is the two-stage least square regression model. The two-stage least squares regression model addresses the problem of endogeneity using instrumental variables. The mediating role of governance on the effectiveness of public health spending on health was considered by an interaction of governance indicators with public health spending. Findings - The results showed that public health spending had no significant effect on health outcome except when interacted with governance quality. The interaction of government health spending with governance effectiveness as well as that for control of corruption improved health by inducing a fall in maternal deaths, whereas government health expenditure interacted with rule of law raised maternal mortality. Public health spending interacted with regulatory quality improved life expectancy while that for political stability with public health spending induced a fall in life expectancy, poor maternal and infant health. Political stability and the control of corruption had direct influence on maternal health. Practical implications - Given the predominance of public health spending in promoting access to health care and population health status for developing economies, the effectiveness of such spending should be top priority in policy makers’ agenda. This again is important because for developing economies, government revenue is generated from a small tax base due to their highly informal nature. To improve health status from public intervention in the health sector, there is indeed need for improvement in the overall state of governance in Nigeria. Originality/value - This paper is one of the few country case studies which uses time series data to examine the role of governance on the efficacy of public health spending with extension of findings to maternal health and covering more measures of governance quality. The results fundamentally illuminate the importance of governance in fostering development in health and consequently enhancing economic development and growth.