Good governance, public health expenditures, urbanization and child undernutrition Nexus in Ethiopia: an ecological analysis

Abstract

BackgroundChild undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia.MethodsThis is pooled data analysis with ecological design. We obtained data on childhood undernutrition from the Ethiopian Demographic and Health Surveys (EDHS) that were conducted in 2000, 2005, 2011 and 2016. Additionally, data on quality of governance for Ethiopia were extracted from the World Governance Indicators (WGI) and public health spending and urbanization were obtained from the World Development Indicators and United Nations’ World Population Prospects (WPP) respectively. Univariate and multivariate analysis were done to assess the relationship between governance, public health expenditure and urbanization with childhood undernutrition.ResultGovernment effectiveness (adjusted odd ratio (AOR) = 20.7; p = 0.046), regulatory quality (AOR = 0.0077; p = 0.026) and control of corruption (AOR = 0.0019; p = 0.000) were associated with stunting. Similarly, government effectiveness (AOR = 72.2; p = 0.007), regulatory quality (AOR = 0.0015; p = 0.004) and control of corruption (AOR = 0.0005; p = 0.000) were associated with underweight. None of the governance indicators were associated with wasting. On the other hand, there is no statistically significant association observed between public health spending and urbanization with childhood undernutrition. However, other socio-demographic variables play a significant effect on reducing of child undernutrition.ConclusionThis study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors. Concerned bodies should focus on improving governance and producing a quality policy and at the same time monitor its implementation and adherence.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3822-2) contains supplementary material, which is available to authorized users.

Does Quality of Government Matter in Public Health?: Comparing the Role of Quality and Quantity of Government at the National Level

“…Gupta et al [16] showed that the relationship between healthcare spending and mortality rates is weak. According to Biadgilign et al [18], there are no statistically significant relationships between public health spending and childhood undernutrition. Moreover, regarding the impact of the quantity of government, Bjørnskov et al [19] showed that a larger government reduces quality of life.…”

“…Compared to complex discussion about the quality of government, the quantitative side of government is reduced to the public expenditure, which generally means the ratio of government spending on public health to total GDP. Gupta et al [16], Biadgilign et al [18], and Rajkumar and Swaroop [24] used the spending on public health as a proxy for quantity of government. Similarly, our study adopted the public expenditure as proxy for quantity of government.…”

“…Second, there has been a theoretical effort to expand the scope of quality of government, develop the type of it, and test the role of developed type of it. Biadgilign et al [18] showed that good governance in Ethiopia plays a significant role in reducing childhood undernutrition; government effectiveness, regulatory quality, and control of corruption were associated with stunting and underweight. Lin et al [31] examined whether or not six dimensions of governance (perceptions of voice and accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption) have an impact on infant mortality.…”

Spillover effects in public healthcare expenditure in Sub‐Saharan Africa: A spatial panel analysis

“…This suggests that during political stability the government allocates more expenditure to healthcare and thus during periods of instability, it is inferred that the government can divert budget allocation away from healthcare expenditure to other non‐healthcare activities, which may include military expenditure. Recently, Biadgilign et al (2019) also find a strong and positive correlation between “political stability and absence of violence” and public healthcare expenditures in Ethiopia.…”

“…Most of the studies on determinants of healthcare expenditure have used demand function approaches to analyse the factors explaining healthcare expenditures, where healthcare expenditures are hypothesized to be a function of income (Newhouse, 1977) and a selection of non‐income variables such as population density (Crivelli et al, 2006; Hosoya, 2014), population's age structure (Barkat, Mrabet, & Alsamara, 2016; Okunade, Karakus, & Okeke, 2004), foreign aid (Barkat et al, 2016; Murthy & Okunade, 2009) and political stability (Biadgilign et al, 2019; Imoughele & Ismaila, 2013). While some models have applied either cross‐section regression (Murthy & Okunade, 2009) or time series regression (Tajudeen, Tajudeen, & Dauda, 2018), most studies have employed panel data models in both developed countries (Baltagi & Moscone, 2010; Murthy & Okunade, 2016) and developing countries (Barkat et al, 2016; Barkat, Sbia, & Maouchi, 2019; Lv & Zhu, 2014).…”