Government Revenue and Child and Maternal Mortality

Stephen Hall,Kyle Mcnabb,Innocent Makuta,Naor Bar-Zeev,Stuart Murray,Andre Python,Bernadette Am O’Hare,Syed Haider Ali Zaidi,Janine Illian

doi:10.1007/s11079-020-09597-0

Stephen Hall, Kyle Mcnabb + Show 7 more

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Most maternal and child deaths result from inadequate access to the critical determinants of health: clean water, sanitation, education and healthcare, which are also among the Sustainable Development Goals. Reasons for poor access include insufficient government revenue for essential public services. In this paper, we predict the reductions in mortality rates — both child and maternal — that could result from increases in government revenue, using panel data from 191 countries and a two-way fixed-effect linear regression model. The relationship between government revenue per capita and mortality rates is highly non-linear, and the best form of non-linearity we have found is a version of an inverse function. This implies that countries with small per-capita government revenues have a better scope for reducing mortality rates. However, as per-capita revenue rises, the possible gains decline rapidly in a non-linear way. We present the results which show the potential decrease in mortality and lives saved for each of the 191 countries if government revenue increases. For example, a 10% increase in per-capita government revenue in Afghanistan in 2002 ($24.49 million) is associated with a reduction in the under-5 mortality rate by 12.35 deaths per 1000 births and 13,094 lives saved. This increase is associated with a decrease in the maternal mortality ratio of 9.3 deaths per 100,000 live births and 99 maternal deaths averted. Increasing government revenue can directly impact mortality, especially in countries with low per- capita government revenues. The results presented in this study could be used for economic, social and governance reporting by multinational companies and for evidence-based policymaking and advocacy.

Highlights

The under-five mortality rate, U5M, is a valid measure of the economic and social development of a country (Wang 2003)
We can formally judge between these models purely based on the model, which gives the highest log-likelihood function as each of them has the same number of parameters and dependent variables
The relationship between government revenue (GR) and U5M/maternal mortality rate (MMR) is more robust in some countries than others, and this may be due to differences in allocation decisions and levels of efficiency

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Introduction

The under-five mortality rate (which is the probability that a liveborn child dies before reaching the fifth birthday), U5M, is a valid measure of the economic and social development of a country (Wang 2003). U5M has been declining across the world since the beginning of the twentieth Century This trend began in western countries following the industrial revolution and has subsequently spread across the globe in association with increasing wealth. The critical determinants of child and maternal survival are access to public services such as clean water, sanitation, education, and health services (Dersarkissian et al 2013; Bishai et al 2016). These rely on adequate levels of both gross domestic product (GDP) per capita (GDPpc) and government revenue (GR) per capita (GRpc). LICs allocate a smaller proportion of their GR to social sectors (Long and Miller 2017)

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