Trends in Between-Country Health Equity in Sub-Saharan Africa from 1990 to 2011: Improvement, Convergence and Reversal.

Jiajie Jin,Jiayan Huang,Lu Shi,Di Liang

doi:10.3390/ijerph13060620

Abstract

It is not clear whether between-country health inequity in Sub-Saharan Africa has been reduced over time due to economic development and increased foreign investments. We used the World Health Organization’s data about 46 nations in Sub-Saharan Africa to test if under-5 mortality rate (U5MR) and life expectancy (LE) converged or diverged from 1990 to 2011. We explored whether the standard deviation of selected health indicators decreased over time (i.e., sigma convergence), and whether the less developed countries moved toward the average level in the group (i.e., beta convergence). The variation of U5MR between countries became smaller from 1990 to 2001. Yet this sigma convergence trend did not continue after 2002. Life expectancy in Africa from 1990–2011 demonstrated a consistent convergence trend, even after controlling for initial differences of country-level factors. The lack of consistent convergence in U5MR partially resulted from the fact that countries with higher U5MR in 1990 eventually performed better than those countries with lower U5MRs in 1990, constituting a reversal in between-country health inequity. Thus, international aid agencies might consider to reassess the funding priority about which countries to invest in, especially in the field of early childhood health.

Highlights

During recent decades, the economies of many countries in Sub-Saharan Africa, a region which ranked at the lowest stratum of population health in the world, have improved substantially
We looked at both sigma convergence and beta convergence metrics to track the variation in selected health indicators (U5MR and life expectancy (LE))
DAH per capita grew faster than that of gross domestic product (GDP) per capita and heath expenditure per capita, while the latter two indictors had a similar rate of growth

Summary

Introduction

The economies of many countries in Sub-Saharan Africa, a region which ranked at the lowest stratum of population health in the world, have improved substantially. As average health indicators of the region improved, one question remains: Has health inequity been reduced over time along with economic development and increased investments?. A number of previous studies have used various metrics to track health inequities in Sub-Saharan Africa [4,5,6]. Most previous studies tended to use indicators based on health financing data (such as health expenditure and public finance data) [9,10] and health service delivery data (such as health service access) [11,12].

Methods

Results

Discussion

Conclusion