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Political determinants of health: (re) examining the role of governance in reducing maternal mortality

Published online by Cambridge University Press:  30 March 2023

Chhavi Tiwari ,
Neha Jain ,
Srinivas Goli Open the ORCID record for Srinivas Goli [Opens in a new window]  and
Parul Puri Open the ORCID record for Parul Puri [Opens in a new window]
Chhavi Tiwari
Affiliation:
Institut national d’études démographiques, 9 Course des Humanités, Aubervillers, Campus Condorcet, 93300 Aubervilliers-Paris, France;
Neha Jain
Affiliation:
Indian Institute of Foreign Trade, New Delhi, India
Srinivas Goli*
Affiliation:
Department of Fertility and Social Demography, International Institute for Population Sciences, Deonar, Mumbai-400 088, India
Parul Puri
Affiliation:
Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India Research Fellow, The George Institute for Global Health, New Delhi, India
*
*Corresponding author. Email: srinivasgoli@iipsindia.ac.in
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Abstract

Given change in the universal developmental agenda and the quality of governance in the last two decades, this paper re-examines the relationship between governance, health expenditure and maternal mortality using panel data for 184 countries from 1996 to 2019. By employing the ‘dynamic panel data regression model’, the study reveals that a one-point improvement in the governance index decreases maternal mortality by 10–21%. We also find that good governance can better translate health expenditure into improved maternal health outcomes through effective allocation and equitable distribution of available resources. These results are robust to alternative instruments, alternative dependent variables (such as infant mortality rate and life expectancy), estimation by different governance dimensions and at the sub-national level. Additional findings using ‘Quantile regression’ estimates show that the quality of governance matters more than the health expenditure in countries with a higher level of maternal mortality. While the ‘Path regression’ analysis exhibits the specific direct and indirect mechanisms through which the causal inference operates between governance and maternal mortality.

Keywords

Governancehealth expenditurematernal mortalitypolitical determinants of health

JEL classification

H51: Government Expenditures and Health I12: Health Behavior I15: Health and Economic Development
Type
Article
Information
Health Economics, Policy and Law , Volume 18 , Issue 3 , July 2023 , pp. 248 - 273
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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Footnotes

†

These authors contributed equally to this work.

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