The Relationship Between Health aid and Health Outcomes and the Role of Domestic Healthcare Expenditure in Developing Countries

Figures & data

Table 1. Summary statistics, 2002–2020.

Variable	Observations	Mean	Standard Deviation	Minimum	Maximum
log_HealthAid	1900	−0.12	1.67	−7.78	3.96
log_DGHE	1900	3.60	1.57	−1.63	6.93
log_DPHE	1900	3.84	1.14	0.85	6.40
log_GDP	1900	7.63	1.03	4.96	10.00
Urb	1900	47.51	19.71	8.68	92.11
WGI	1900	−0.53	0.51	−1.78	0.86
sqrt_IM	1900	5.84	2.03	2.03	11.56
LE	1900	66.00	8.20	42.12	80.12

Table 2. Fixed effects estimation (direct effect, infant mortality).

Variables	(1)	(2)	(3)
log_HealthAid	−0.023*** (0.009)	−0.030** (0.008)	−0.029*** (0.008)
log_GDP	−0.154*** (0.033)	−0.160*** (0.032)	−0.170*** (0.030)
Urb	−0.004 (0.004)	−0.005 (0.004)	−0.007** (0.004)
WGI	−0.119*** (0.047)	−0.101*** (0.045)	−0.085*** (0.043)
R^2	0.026	0.032	0.037
No. of observations	1900	1800	1700
No. of countries	100	100	100

Notes: Standard errors are in parentheses. Country and year effects are included in the regressions. Model (1) includes current values; Model (2) includes a one-year lag; Model (3) includes a two-year lag.

*Significant at 10%.

**Significant at 5%.

***Significant at 1%.

Table 3. Fixed effects estimation (direct effect, life expectancy).

Variables	(4)	(5)	(6)
log_HealthAid	0.250*** (0.046)	0.310*** (0.046)	0.315*** (0.047)
log_GDP	−0.776*** (0.170)	−0.762*** (0.173)	−0.599*** (0.174)
Urb	0.065*** (0.020)	0.057*** (0.020)	0.054*** (0.020)
WGI	−0.054 (0.245)	−0.168 (0.244)	−0.249 (0.244)
R^2	0.036	0.045	0.044
No. of observations	1900	1800	1700
No. of countries	100	100	100

Notes: Standard errors are in parentheses. Country and year effects are included in the regressions. Model (4) includes current values; Model (5) includes a one-year lag; Model (6) includes a two-year lag.

* Significant at 10%.

** Significant at 5%.

*** Significant at 1%.

Table 4. Fixed effects estimation (mediation effect, domestic government health expenditure).

Variables	(7)	(8)	(9)
log_HealthAid	−0.011 (0.008)	−0.009 (0.009)	0.001 (0.009)
log_GDP	0.873*** (0.031)	0.799*** (0.033)	0.662*** (0.035)
Urb	0.010*** (0.004)	0.010*** (0.004)	0.010*** (0.004)
WGI	0.273*** (0.045)	0.279*** (0.046)	0.298*** (0.050)
R^2	0.368	0.320	0.238
No. of observations	1900	1800	1700
No. of countries	100	100	100

Notes: Standard errors are in parentheses. Country and year effects are included in the regressions. Model (7) includes current values; Model (8) includes a one-year lag; Model (9) includes a two-year lag.

* Significant at 10%.

** Significant at 5%.

*** Significant at 1%.

Table 5. Fixed effects estimation (total effect, infant mortality).

Variables	(10)	(11)	(12)
log_HealthAid	−0.023*** (0.009)	−0.030*** (0.008)	−0.029*** (0.008)
log_DGHE	0.024 (0.025)	0.029 (0.024)	0.031 (0.023)
log_GDP	−0.176*** (0.039)	−0.185*** (0.038)	−0.197*** (0.036)
Urb	−0.004 (0.004)	−0.006 (0.004)	−0.007** (0.004)
WGI	−0.125*** (0.047)	−0.109*** (0.045)	−0.095*** (0.043)
R^2	0.027	0.033	0.039
No. of observations	1900	1800	1700
No. of countries	100	100	100

Notes: Standard errors are in parentheses. Country and year effects are included in the regressions. Model (10) includes current values; Model (11) includes a one-year lag; Model (12) includes a two-year lag.

* Significant at 10%.

** Significant at 5%.

*** Significant at 1%.

Table 6. Fixed effects estimation (total effect, life expectancy).

Variables	(13)	(14)	(15)
log_HealthAid	0.201*** (0.046)	0.299*** (0.046)	0.306*** (0.046)
log_DGHE	−0.707*** (0.129)	−0.714*** (0.128)	−0.765*** (0.127)
log_GDP	−0.159 (0.203)	−0.135 (0.205)	0.067 (0.205)
Urb	0.072*** (0.019)	0.067*** (0.020)	0.067*** (0.020)
WGI	0.139 (0.246)	0.040 (0.244)	−0.013 (0.245)
R^2	0.052	0.063	0.065
No. of observations	1900	1800	1700
No. of countries	100	100	100

Notes: Standard errors are in parentheses. Country and year effects are included in the regressions. Model (13) includes current values; Model (14) includes a one-year lag; Model (15) includes a two-year lag.

* Significant at 10%.

** Significant at 5%.

*** Significant at 1%.

Table 7. Robustness check (direct effect).

Variables	(16)	(17)	(18)	(19)	(20)	(21)
log_HealthAid	−0.023*** (0.009)	−0.030*** (0.009)	−0.029*** (0.008)	0.249*** (0.046)	0.310*** (0.046)	0.316*** (0.046)
log_DPHE	−0.087*** (0.026)	−0.092*** (0.025)	−0.096*** (0.024)	−0.841*** (0.136)	−0.735*** (0.138)	−0.650*** (0.139)
Urb	−0.005 (0.004)	−0.006** (0.004)	−0.008*** (0.004)	0.054*** (0.020)	0.048*** (0.020)	0.046*** (0.021)
WGI	−0.148*** (0.046)	−0.128*** (0.044)	−0.113*** (0.042)	−0.025 (0.240)	−0.165 (0.240)	−0.212 (0.021)
R^2	0.020	0.025	0.028	0.045	0.050	0.050
No. of observations	1,900	1,800	1,700	1,900	1,800	1,700
No. of countries	100	100	100	100	100	100

Notes: Standard errors are in parentheses. Country and year effects are included in the regressions. Model (16) and (19) include current values; Model (17) and (20) include a one-year lag; Model (18) and (21) include a two-year lag. Model (16), (17) and (18) refer to infant mortality; Model (19), (20) and (21) refer to life expectancy.

* Significant at 10%.

** Significant at 5%.

*** Significant at 1%.

Table 8. Robustness check (mediation effect).

Variables	(22)	(23)	(24)
log_HealthAid	−0.013 (0.009)	−0.009 (0.010)	−0.001 (0.010)
log_DPHE	0.472*** (0.029)	0.385*** (0.029)	0.287*** (0.030)
Urb	0.015*** (0.004)	0.014*** (0.004)	0.012*** (0.004)
WGI	0.449 *** (0.049)	0.446*** (0.051)	0.441*** (0.053)
R^2	0.213	0.166	0.119
No. of observations	1,900	1,800	1,700
No. of countries	100	100	100

Notes: Standard errors are in parentheses. Country and year effects are included in the regressions. Model 22) includes current values; Model (23) includes a one-year lag; Model (24) includes a two-year lag.

* Significant at 10%.

** Significant at 5%.

*** Significant at 1%.

Table 9. Robustness check (total effect).

Variables	(25)	(26)	(27)	(28)	(29)	(30)
log_HealthAid	−0.023*** (0.009)	−0.030*** (0.009)	−0.029*** (0.008)	0.241*** (0.046)	0.300*** (0.046)	0.307*** (0.046)
log_DGHE	−0.014 (0.022)	−0.011 (0.021)	−0.011 (0.020)	−0.598*** (0.115)	−0.637*** (0.114)	−0.644*** (0.114)
log_DPHE	−0.080*** (0.028)	−0.087*** (0.027)	−0.091*** (0.026)	−0.559*** (0.146)	−0.445*** (0.146)	−0.359*** (0.147)
Urb	−0.005 (0.004)	−0.006 (0.004)	−0.007*** (0.004)	0.063*** (0.020)	0.060*** (0.200)	0.059*** (0.020)
WGI	−0.142*** (0.047)	−0.123*** (0.045)	−0.108*** (0.043)	0.244 (0.244)	0.128 (0.243)	0.088 (0.242)
R^2	0.020	0.025	0.028	0.059	0.068	0.068
No. of observations	1,900	1,800	1,700	1,900	1,800	1,700
No. of countries	100	100	100	100	100	100

Notes: Standard errors are in parentheses. Country and year effects are included in the regressions. Model (25) and (28) include current values; Model (26) and (29) include a one-year lag; Model (27) and (30) include a two-year lag. Model (25), (26) and (27) refer to infant mortality; Model (28), (29) and (30) refer to life expectancy.

* Significant at 10%.

** Significant at 5%.

*** Significant at 1%.

Table 10. Instrumental variable estimation (2SLS).

	(31)	(32)	(33)	(34)	(35)	(36)
	First stage	Second stage
Dependent variable	log_HealthAid	log_DGHE	IM_sqrt	LE	IM_sqrt	LE
log_HealthAidit-2	0.385*** (0.023)	–	–	–	–	–
Instrument	–	−0.020 (0.022)	−0.076*** (0.021)	0.837*** (0.120)	−0.075*** (0.021)	0.825*** (0.120)
log_DGHE	–	–	–	–	0.036 (0.024)	−0.605*** (0.134)
log_GDP	−0.076 (0.090)	0.860*** (0.033)	−0.129*** (0.031)	−0.721*** (0.177)	−0.160*** (0.038)	−0.200 (0.210)
Urb	0.008 (0.011)	0.010*** (0.004)	−0.003 (0.004)	0.059*** (0.022)	−0.004 (0.004)	0.065*** (0.022)
WGI	0.327*** (0.132)	0.298*** (0.050)	0.019 (0.047)	−0.945*** (0.266)	0.009 (0.048)	−0.765*** (0.267)
R^2	0.152	0.363	0.020	0.058	0.021	0.070
F-statistic	70.768	225.035	8.045	24.506	6.893	23.932

Notes: The first stage (Model (31)) obtains predicted values of the endogenous variable (log_HealthAid). The second stage uses fitted values of the instrument (log_HealthAid_it-2) to address endogeneity. Standard errors are in parentheses. Country and year effects are included in the regressions. All models use current values of the predictor variables. Model (32) estimates the mediation effect, Model (33) and (34) estimate the direct effect, and Model (35) and (36) estimate the total effect.

* Significant at 10%.

** Significant at 5%.

*** Significant at 1%.

Figure A1. Per capita domestic government health spending (averages in constant 2015 USD) in 100 countries, 2002–2020.

Figure A2. Per capita health aid disbursements (averages in constant 2015 USD) for 100 countries, 2002–2020.

Figure A3. Infant mortality rates (averages) for 100 countries, 2002–2020.

Figure A4. Life expectancy rates (averages) for 100 countries, 2002–2020.

Figure A5. Scatterplot matrix.

Table AI. Overview of variables.

Variable	Measure	Time span	Source
Domestic government expenditure	Domestic government expenditures on health per capita in constant 2015 US dollars	2002–2020	World Development Indicators
Domestic private expenditure	Domestic private expenditures on health per capita in constant 2015 US dollars	2002–2020	World Development Indicators
Gross domestic product	GDP per capita in constant 2015 US dollars	2002–2020	World Development Indicators
Health aid	ODA for health per capita in constant 2015 US dollars	2002–2020	OECD Creditor Reporting System
Infant mortality	Number of infants that die before completing their first year of age (measured per 1,000 live births each year)	2002–2020	World Development Indicators
Life expectancy	Life expectancy of a new-born at birth, assuming current mortality patterns remain constant	2002–2020	World Development Indicators
Urbanisation	Urban population as percentage of the total population	2002–2020	World Development Indicators
Worldwide Governance Indicators	Average of the six dimensions measured by the WGI as a measure of governance	2002–2020	The World Bank

Table A2. List of countries.

All countries
Afghanistan	Cuba	Kazakhstan	Pakistan
Algeria	DR Congo	Kenya	Panama
Angola	Dominican Republic	Kyrgyzstan	Papua New Guinea
Argentina	Ecuador	Lao PDR	Paraguay
Armenia	Egypt	Lebanon	Peru
Azerbaijan	El Salvador	Lesotho	Philippines
Bangladesh	Equatorial Guinea	Liberia	Rwanda
Benin	Eswatini	Madagascar	Samoa
Bhutan	Ethiopia	Malawi	Senegal
Bolivia	Fiji	Malaysia	Serbia
Bosnia and Herzegovina	Gabon	Maldives	Sierra Leone
Botswana	Gambia	Mali	South Africa
Brazil	Georgia	Mauritania	Sri Lanka
Burkina Faso	Ghana	Mexico	Sudan
Burundi	Guatemala	Moldova	Suriname
Cabo Verde	Guinea	Mongolia	Tajikistan
Cambodia	Guinea-Bissau	Morocco	Tanzania
Cameroon	Guyana	Mozambique	Thailand
Central African Republic	Haiti	Myanmar	Togo
Chad	Honduras	Namibia	Tunisia
China	India	Nepal	Türkiye
Colombia	Indonesia	Nicaragua	Uganda
Congo	Iran	Niger	Uzbekistan
Costa Rica	Jamaica	Nigeria	Vietnam
Côte d'Ivoire	Jordan	North Macedonia	Zambia