Health Spending, Democracy and Child Mortality in Developing Countries

This paper assesses the impact of health spending on child mortality in the developing countries, taking into account the role of democracy. We use the two-stage dynamic panel generalized method of moments. Our sample covers 126 countries over the period 1995-2017. Our main results show that health expenditure is negatively and significantly associated with child mortality. However, when we take into account democracy, regionalization and the income level, we find that, health expenditure has a negative and significant effect on child mortality only in the upper-middle-income countries and Sub-saharan Africa. Elsewhere, it is in the countries of Eurasia, North Africa, and Latin America that a significant reduction in the child mortality rate takes place in the presence of democratic institutions; to this must be added the least developed countries. For example, respect for civil liberties, control of government by a democratically elected parliament, combined with spending on health care, contribute to a significant decrease in child mortality. The results of this study are an important issue for policymakers, providing them with a kind of theoretical and empirical argument presenting health expenditure as a major determinant in public health policy. Thus, in their fight against child mortality, it is in the interest of governments in developing countries to improve not only the quality of their health spending but also, and above all, their institutional framework, especially democratic governance.