Child mortality and public health spending: is good governance the missing key?

Abstract Until this day, child mortality rates are strikingly high and severe inequalities between countries and population groups exist. The direct cause of child mortality are strongly influenced by underlying, socioeconomic factors. The literature shows much potential for public health spending to decrease child mortality through government programs. However, in practice is the effect of public health spending very disappointing. This gap between the potential of public health spending and the actual results could be due to the ineffectiveness of public health spending. This ineffectiveness could be attributable to a low quality of governance. Therefore, is the main hypothesis of this thesis: the better quality of governance a country has, the more influence public spending on health has on decreasing the under-5 mortality rate. The quality of governance is measured as the score on four different good governance indicators, namely control of corruption; government effectiveness; voice and accountability; and political stability and absence of violence. The main hypothesis is tested by including moderator variables of all the good governance indicators into a base model of factors influencing the child mortality rate. However, the empirical results show that the influence of the different good governance indicators on the relationship between public health spending and child mortality rate is rather low and most of the times insignificant. Also, public health spending does not have a significant influence on the child mortality rate. Furthermore. this thesis shows that income, access to sanitation and female education are the most important factors influencing child mortality rates. Therefore should policies from the national governments and from the international community be aimed at stimulating the economic development of a country. However, because public health spending is vital for providing equity in health care, this thesis suggests that more research most be conducted on the effectiveness of public health spending for decreasing child mortality.