RESEARCH UNDERPINNING THE GRADE MODEL
Government Revenue and Child and Maternal Mortality
Highlights
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.
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.
Significance of the Study
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.
Research Approach
Previous research used a double log specification: this has the advantage of making the coefficients easily interpretable as elasticities. However, it limits the degree of non-linearity, as the same elasticity applies across countries. It is improbable that the pooling assumption will hold across a large number of countries. thers use a deterministic trend treatment to explain differences between countries, but the problem with this approach is that it has no policy implications. We reject this view and believe that proactive policies can bring countries with high U5M/MMR rates into line with the rest of the world.
We focus on a model which explains U5M/MMR through government resources, measured by GRpc, a range of health care indicators drawn from the SDGs, and adopt a two-way fixed-effects specification and explore a range of non-linear functions to link GRpc to the two independent variables U5M and MMR.
Study Results
We find that the log inverse specification is superior and remains positive (the correct sign) and statistically significant
∂U5M/∂GR = − β/GR (squared) and ∂MMR/∂log GR = − β/ (log GR)squared
Conclusions
An increase in GR is associated with a reduction in U5M/MMR.
We have made no assumptions about the allocation of GR or the efficiency of its use. Instead, we have modelled based on the past relationship.
The pathways between GR and mortality are likely to act via GS on public services and access to the determinants of health.
The relationship between GR and U5M/MMR is more robust in some countries than others, and this may be due to differences in allocation decisions and levels of efficiency