Wealthiest Is Not Always Healthiest: What Explains Differences in Child Mortality in West Africa?

Ghana has the lowest under-five mortality rate in West Africa. Understanding why Ghana’s child mortality rate is lower than in neighboring countries may offer useful insights for other developing countries that are trying to improve child health. This paper explores whether Ghana’s lower mortality rate is mostly a result of greater household wealth, better implementation of national health policies, or more favorable geography. The paper uses micro level data for children under five to examine relative child mortality risk between Ghana and each of its three immediate neighbors -- Burkina Faso, Côte d’Ivoire, and Togo. A Cox proportional hazards model is used to test which of the three ‘contenders’ – health policy, wealth, or geography – best explains Ghana’s mortality advantage. The results of the analysis indicate that wealth variables are not able to explain any of the child mortality variation between Ghana and its neighbors. Geography and health policy variables each explain about 40% of the mortality gap between Ghana and Burkina Faso. Health policy differences alone are able to explain about 70% of the child mortality gap between Ghana and Côte d’Ivoire. These results suggest that even poor countries that have been ‘cursed’ by bad geography can potentially improve development outcomes and save children’s lives.