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Public Health Spending Efficiency in Sub‐Saharan African Countries: How to Deal With Public Debt and Fiscal Deficit?

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  • Yrkamba Bienvenu Amakoue
  • Askandarou Cheik Diallo

Abstract

This paper empirically examines the impact of public debt and fiscal deficit on public health spending efficiency (PHSE) using data from 36 Sub‐Saharan African countries between 2000 and 2019. PHSE scores are calculated via bias‐corrected data envelopment analysis (bootstrap DEA), and a beta regression approach estimates the effects of debt and deficit on PHSE. Findings indicate that most SSA countries have low PHSE scores. Higher public debt and fiscal deficits are negatively associated with PHSE. The impact varies with fiscal rules adoption and public financial management performance. Results are robust across different samples, efficiency measures, estimation methods and additional controls.

Suggested Citation

  • Yrkamba Bienvenu Amakoue & Askandarou Cheik Diallo, 2026. "Public Health Spending Efficiency in Sub‐Saharan African Countries: How to Deal With Public Debt and Fiscal Deficit?," Journal of International Development, John Wiley & Sons, Ltd., vol. 38(1), pages 48-70, January.
    • Handle: RePEc:wly:jintdv:v:38:y:2026:i:1:p:48-70
    DOI: 10.1002/jid.70032
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    References listed on IDEAS

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