Development assistance for health: Trend and effects on health outcomes in Ethiopia and Sub-Saharan Africa
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Date
2016-06
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Addis Ababa Universty
Abstract
Background: For decades, health targeted aid in the form of development assistance for
health has been an important source of financing health sectors in developing countries.
Health sectors in Sub Saharan countries in general and Ethiopia in particular, are even more
heavily reliant upon donors. Consequently, a more audible donors support to health sectors
was seen during the last four decades, consistent with the donor's response to the global goal
of Alma-Ata declaration of “health for all by the year 2000” through primary health care in
1978. Ever since, a massive surge of development assistance for health has followed the out
gone of the 2015 United Nations Millennium Declaration Goals in which three out of the
eight goals were directly related to health. In spite of the long history of health targeted aid,
with an ever increasing volumes, there is an increasing controversy on the extent to which
health targeted aid is producing the intended health outcomes in the recipient countries.
Despite the vast empirical literatures considering the effect of foreign development aid on
economic growth of the recipient countries, systematic evidence that health sector targeted
aid improves health outcomes is relatively scarce. The main contribution of this study is,
therefore, to present a comprehensive country level, and cross-country evidences on the effect
of development assistance for health on health outcomes.
Objectives: The overall objective of this study was to analyze the effect of development
assistance for health on health outcomes in Ethiopia, and in Sub Saharan Africa.
Methods: For the Ethiopian (country level) study, a dynamic time series data analytic
approach was employed. A retrospective sample of 36-year observations from 1978 to 2013
was analyzed using an econometric technique - vector error correction model. Beside
including time dependency between the variables of interest and allowing for stochastic
trends, the model provides valuable information on the existence of long-run and short-run
relationships among the variables under study. Furthermore, to estimate the co-integrating
relations and the other parameters in the model, the standard procedure of Johansen’s
approach was used. While development assistance for health expenditure was used as an
explanatory variable of interest, life expectancy at birth was used as a dependent variable for
the fact that it has long been used with or without mortality measures as health status
indicators in the literatures.In the Sub Saharan Africa (cross-country level) study, a dynamic panel data analytic
approach was employed using fixed effect, random effect, and the first difference-generalized
method of moments estimators in the period confined to the year 1995-2013 over the cross
section of 43 SSA countries. While development assistance for health expenditure was used
as an explanatory variable of interest here again, infant mortality rate was used for health
status measure done for its advantage over other mortality measures in cross-country studies.
Results: In Ethiopia, the immediate one and two prior year of development assistance for
health was shown to have a significant positive effect on life expectancy at birth. Other things
being equal, an increase of development assistance for health expenditure per capita by 1%
leads to an improvement in life expectancy at birth by about 0.026 years (P=0.000) in the
immediate year following the period, and 0.008 years following the immediate prior two
years period (P= 0.025).
Similarly, in Sub-Saharan Africa, development assistance for health was found to have a
strong negative effect on the reduction of infant mortality rate. The estimates of the study
result indicated that during the covered period of study, in the region, a 1% increase in
development assistance for health expenditure, which is far less than 10 cents per capita at the
mean level, saves the life of two infants per 1000 live births (P=0.000).
Conclusion: Contrary to the views of health aid skeptics, this study indicates strong
favorable effect of development assistance for health sector in improving health status of
people in Sub Saharan Africa in general and the Ethiopia in particular.
Recommendations: The policy implication of the current findings is that development
assistance for health sector should continue as an interim necessity means. However,
domestic health financing system should also be sought, as the targeted countries cannot rely
upon external resources continuously for improving the health status of the population.
At the same time, the current development assistance stakeholders assumption of targeting
facility based primary health care provision should be augmented by a more strong parallel
strategy of improving socioeconomic status of the population that promotes sustainable
improvement of health status in the targeted countries.
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Keywords
health targeted aid,Ethiopia and Sub-Saharan Africa