Threshold effect of governance quality in the relationship between public health expenditure and life expectancy at birth in the West African Economic and Monetary Union

Abstract

Abstract Background The population in the West African Economic and Monetary Union (WAEMU) suffers poor health, as manifested in low life expectancy at birth. Public health expenditure (PHE) has long been viewed as having the potential to improve health. However, the relationship between PHE and health outcomes is inconclusive. In view of the above, poor governance could be a factor inhibiting the effect of public health expenditure on certain health indicators. This article analyzes the threshold effect of governance quality on the relationship between public health spending and life expectancy at birth in WAEMU.Methods The data used come from the Worldwide Governance Indicators (WGI) database and the World Bank's World Development Indicators and cover the period 1996–2018. Threshold-effect analysis for Hansen (1999) was performed to assess the relation between governance quality and public health expenditure with life expectancy at birth.Result The results show that governance quality is a transition variable at which public health expenditure affects life expectancy. Indeed, for public health spending to have a positive and significant effect on life expectancy at birth, the level of governance quality must be above 0.42 on a 0–1 scale.Conclusion Public health expenditure affects life expectancy if the quality of governance is high. Improving governance quality must be a prerequisite for any allocation of public resources in the health sector in WAEMU.