The Impact of Domestic Public Health Spending on Health Outcomes in Sub‐Saharan Africa: Evidence From Disability‐Adjusted Life Years
- 1School of Accounting, Economics and Finance University of KwaZulu‐Natal Durban South Africa
Abstract
Sub‐Saharan Africa (SSA) continues to experience a high and uneven disease burden, mainly from HIV/AIDS, tuberculosis, and malaria. As external funding declines, the strategic allocation of domestic public health spending (DPHS) becomes crucial. This study assesses whether directing DPHS towards major diseases and high‐burden areas improves health outcomes across 43 SSA countries between 2003 and 2022, using DALYs as the outcome measure. Results show a statistically significant positive relationship between DPHS and DALYs: HIV‐specific models yield coefficients of 0.105–0.288 (p < 0.01), and all‐cause models yield coefficients of 0.071–0.085 (p < 0.05), while other models are insignificant. The paradoxical positive association—stronger in high‐burden settings—suggests that DPHS is reactive, mainly used to address existing disease burdens rather than prevent them. The significant persistence of DALYs, especially in low‐burden and high‐burden contexts, further indicates that spending is directed towards treatment and case management rather than preventive measures. The DPHS effect on tuberculosis or malaria outcomes in DALYs is slightly greater in low‐burden areas. Beyond health spending, factors such as economic growth, inequality, population ageing, and governance substantially influence health outcomes. Overall, the findings highlight that while DPHS remains essential, its current reactive deployment limits effectiveness. A systemic shift is needed towards proactive, preventive approaches with targeted health interventions to reduce the region's disease burden.
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BibTeX
@article{kabongo2026impact,
title = {{The Impact of Domestic Public Health Spending on Health Outcomes in Sub‐Saharan Africa: Evidence From Disability‐Adjusted Life Years}},
author = {Wa Ntita Serge Kabongo and Josue Mbonigaba},
journal = {The International Journal of Health Planning and Management},
year = {2026},
month = aug,
doi = {10.1002/hpm.70104},
url = {https://doi.org/10.1002/hpm.70104},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - The Impact of Domestic Public Health Spending on Health Outcomes in Sub‐Saharan Africa: Evidence From Disability‐Adjusted Life Years
AU - Wa Ntita Serge Kabongo
AU - Josue Mbonigaba
PY - 2026
DA - 2026/08/12
JO - The International Journal of Health Planning and Management
DO - 10.1002/hpm.70104
UR - https://doi.org/10.1002/hpm.70104
AB - Sub‐Saharan Africa (SSA) continues to experience a high and uneven disease burden, mainly from HIV/AIDS, tuberculosis, and malaria. As external funding declines, the strategic allocation of domestic public health spending (DPHS) becomes crucial. This study assesses whether directing DPHS towards major diseases and high‐burden areas improves health outcomes across 43 SSA countries between 2003 and 2022, using DALYs as the outcome measure. Results show a statistically significant positive relationship between DPHS and DALYs: HIV‐specific models yield coefficients of 0.105–0.288 (p < 0.01), and all‐cause models yield coefficients of 0.071–0.085 (p < 0.05), while other models are insignificant. The paradoxical positive association—stronger in high‐burden settings—suggests that DPHS is reactive, mainly used to address existing disease burdens rather than prevent them. The significant persistence of DALYs, especially in low‐burden and high‐burden contexts, further indicates that spending is directed towards treatment and case management rather than preventive measures. The DPHS effect on tuberculosis or malaria outcomes in DALYs is slightly greater in low‐burden areas. Beyond health spending, factors such as economic growth, inequality, population ageing, and governance substantially influence health outcomes. Overall, the findings highlight that while DPHS remains essential, its current reactive deployment limits effectiveness. A systemic shift is needed towards proactive, preventive approaches with targeted health interventions to reduce the region's disease burden.
SN - 0749-6753
SN - 1099-1751
ER -