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Archives of Business Research – Vol. 8, No. 8
Publication Date: August 25, 2020
DOI: 10.14738/abr.88.8858.
Madinah, N. (2020). The Impact Of The Country’s Health Services’ Expenditure On The Success Of Mdgs, Goal 4/Sdg 3: Reduction Of
Child Mortality In Uganda (2000-2016). Archives of Business Research, 8(8). 69-82.
The Impact Of The Country’s Health Services’ Expenditure On The
Success Of Mdgs, Goal 4/Sdg 3: Reduction Of Child Mortality In
Uganda (2000-2016)
Nabukeera Madinah
Islamic University Uganda, Females’ Campus
Faculty of Management Studies
Dept. of Public Administration
ABSTRACT
Safeguarding access to health services is a serious challenge for poor
countries if the Sustainable Development Goals are to (SDGs) are to be
achieved. This paper scrutinizes the case of Uganda, a country which is
trying to improve its health sector amid a lot of challenges between
2000-2016 to assess how the country has performed in the reduction
of child mortality given its expenditure. This study involved analyzing
the available data drawn from various sources i.e., time series data on
public health expenditure was obtained from Ministry of Health
reports and the budget and Ministerial Policy Statements for the period
2000-2016. This data was further demarcated into parameters such as
per capita government spending on health in Uganda shillings, health
spending as a proportion of Gross Democratic Product (GDP) and
private health spending as a proportion of total health spending.
Findings revealed that non-significant negative effect of GDP per capita
growth on infant mortality rate from 2000 to 2016, a negative effect of
GDP per capita on under-five mortality in Uganda from 2000 to 2016,
albeit the effect is non-significant (P>0.05), decline in Maternal
Mortality Rate (MMR) from 527 death per 100,000 live birth in 1995 to
336 death per 100,000 live birth in 2016, and there is a negative but
insignificant effect of health sector budget allocation on the MMR in
Uganda since the P-value (0.199). Maternal mortality fell significantly
in Uganda due to some interventions in the health sector. The decline
is likely to have been cause due to supply and demand situations. There
is need to improve funding in the health sector in order to improve
quality health services through better coordination, health
management, transportation, access, infrastructure at the district level.
Key words: Health services, MDGs, Goal 4/SDG 3, Child Mortality and
Uganda.
INTRODUCTION
Under the commitment to the right to development, to peace and security, to gender equality, to
the eradication of the many dimensions of poverty and to sustainable human development, at the
beginning of the new millennium, world leaders gathered at the United Nations and proclamated
the United Nations Millennium Declaration of 2000. Embedded in that Declaration, which was
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URL: http://dx.doi.org/10.14738/abr.88.8858 70
Madinah, N. (2020). The Impact Of The Country’s Health Services’ Expenditure On The Success Of Mdgs, Goal 4/Sdg 3: Reduction Of Child Mortality
In Uganda (2000-2016). Archives of Business Research, 8(8). 69-82.
adopted by 147 heads of State and 189 states, were what have become known as the eight
Millennium Development Goals (MDGs), including 18 time bound targets, and agreed to be
achieved by the year 2015 (UN, 2015a). Out of these MDGs was Goal 4: Reduce child mortality,
which is the focus of this paper. MDG 4 only target 4.A was reduce by two-thirds, between 1990
and 2015, the under-five mortality rate, and with 3 indicators for monitoring progress as; under- five mortality rate, infant mortality rate, and proportion of 1 year-old children immunised against
measles (UN, 2015b).
Health care is a core component of human capital investment, which in turn rising its spending also
raises quality of life, prolonged life expectancy, reducing morbidity and mortality rates (N. V.
Murthy & Okunade, 2000; V. N. Murthy & Okunade, 2009). On other hand, health outcomes
symbolize how healthy a country is and assesses the quality of health care in the country (Deluna
Jr & Peralta, 2014). Thus, infant and under-five mortality are known to be the most important
indicators for early childhood development and health status of population for given countries
(Deluna Jr & Peralta, 2014; Ssozi & Amlani, 2015). By definition, the under-five mortality rate is the
probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying before
reaching the age of five if subject to current age-specific mortality rates. Similarly, the infant
mortality rate is typically defined as the number of infants dying before reaching the age of one
year per 1,000 live births in a given year (UN, 2015b).
Mortality Rate (MR) is one of the most vital health indicators and is impacted and influenced by a
number of factors. One of the most important one could be public health spending (Shetty & Shetty,
2014). In fact government spending on health and public health indicators suggested that public
health spending had an important influence upon health and particularly upon infant mortality
(Franco, Gil, & Álvarez-Dardet, 2005). Therefore, health care expenditure remains a crucial
component of health status improvement in sub-Saharan African countries (Novignon, Olakojo, &
Nonvignon, 2012). To this effect, the government of Uganda stepped up the expenditure on health
tremendously for example Uganda’s total health expenditure increased from 280.9 billion Uganda
shillings in 2008/9 to 930.5billion Uganda shillings in 2013/14 (Kato, Mugarura, Kaberuka,
Matovu, & Yawe, 2018).
Furthermore, while the poverty levels in Uganda have been declining over the years from 52% in
1992/93 to 19.7% in 2013, under-five mortality has remained high and stagnant around 90 per
1000 live births in 2012 (GoU, 2013). Under five mortality rate reduced from 137 per 1,000 live
births in 2007 to 90 per 1000 live birth in 2012 way above the Millennium Development Goals
(MDG) target of 56 per 1000 live births in 2015 (GoU, 2013). Effective health reforms have been
implemented such as Immunization, Integrated Management of Childhood illness and Home Based
Management of Fever with hope of reducing under-five mortality to MDG target (Kato et al., 2018).
Monitoring of the Millennium Development Goals is taking place globally, through annual reports
of the United Nations Secretary-General to the General Assembly and through periodic country
reporting. For global reporting, use is made of indicators compiled by international organizations.
For country reporting, use is generally made of indicators compiled from national sources,
generally by the national statistical system. The metadata sheets for the indicators reflect national
and international standards (UN, 2015a). Globally, under-five mortality rate has decreased by 53%,
from an estimated rate of 91 deaths per 1000 live births in 1990 to 43 deaths per 1000 live births
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in 2015. The average annual rate of reduction in under-five mortality has accelerated from 1.8% a
year over the period 1990–2000 to 3.9% for 2000–2015 but remains insufficient to reach MDG 4
(WHO, 2010, 2018) and about 19 000 fewer children died every day in 2015 than in 1990.
The government of Uganda has continued increasing the proportion of per capita health
expenditure every year as mechanism of improving the status of health sector with the hope of
increasing accessibility and quality that would bring efficiency and effectiveness in the health
sector service delivery. The total expenditure on health as a percentage of GDP was 8.5 percent in
2015 (WB, 2015, 2018), and quite number of strategies to improve the health status in the country
were implemented with the purpose of achieving MDGS targets such as reducing under-five
mortality by two thirds in 2015. Despite these initiatives, the under-five mortality rate has reduced
at a slow rate and has remained high compared to MDGs target of reducing it by 2/3 by 2015 (56
deaths per1000 live births). To illustrate this, the Ministry of Health Annual health sector
performance report for financial year (FY) 2014/2015 indicated that about 69 death cases
occurred among the child under-five years in 2014 (GoU, 2015a). This makes everyone to wonder
whether there is or not a correlation between increased public health expenditure and improved
health status in particular child health care and reduction in child mortality. This study therefore
set out to examine if there is a positive relationship between public spending on health expenditure
and reduction of under-five mortality rate in Uganda according to the MDGs’ target 4A.
Objective
i. To examine the effect of GDP per capita and public health expenditure as a share of GDP on
infant mortality in Uganda from 2000 to 2016
ii. To examine the effect of GDP per capita and public health expenditure as a share of GDP on
under-five mortality in Uganda from 2000 to 2016
iii. To establish the relationship between expenditure on health services and infant mortality
rate in Uganda from 2000-2016
The main objective of this study was to examine if there is a positive relationship between public
health expenditure and health outcome of reduction in child mortality (infant and under five
mortality rate) in Uganda over the period 2000 to 2015, the MDGs’ timeframe. This is because one
assumes that rapid economic growth and declining poverty levels in Uganda over the years from
52% in 1992/93 to 19.7% in 2013 plus sustained increase in public health expenditure and several
childcare initiatives would signified an improved health care in the country where the under-five
mortality rate is low but interestingly instead it has remained around 90 per 1000 live births in
2012 (GoU, 2013), way above the Millennium development Goals (MDG) target of 56 per 1000 live
births in 2015 (GoU, 2015b).
Ha1: GDP per capita and public health expenditure as a share of GDP have a significant effect on
infant mortality in Uganda from 2000 to 2016
Ha2: GDP per capita and public health expenditure as a share of GDP have a significant effect on
under-five mortality in Uganda from 2000 to 2016
Ha3: Expenditure on health services is significantly related with infant mortality rate in Uganda
from 2000-2016