Effects of public expenditure assignment by regions in Kazakhstan to reduce infant and child mortality

Figures & data

Figure 1. Evolution of infant and under-5 child mortality in Kazakhstan (average and regional variation).

Figure 2. Mortality corrected.

Table 1. Descriptive statistics

	Mean	SD	CV	Min	Max
Infant mortality	20.24	11.21	0.55	5.55	54.06
Under-5 child mortality	23.50	12.83	0.55	7.00	63.17
GDPpc	694,095.83	524,975.50	0.76	104,458.68	2,883,026.00
PublicExpendpc	12,013.03	4,414.57	0.37	2,454.81	31,853.81
hExpendassign	0.92	0.27	0.29	0.40	2.94
bedspc14	5.13	1.61	0.31	2.36	10.56
physicianspc	38.36	16.40	0.43	0.00	95.91
%pediatricians	9.84	2.43	0.25	5.03	16.05
urbanization rate	57.08	20.09	0.35	23.02	100.00
%pop14	25.35	4.99	0.20	17.88	36.44
Year 2000
Infant mortality	39.38	8.18	0.21	26.91	54.06
Under-5 child mortality	46.76	10.75	0.23	22.55	61.08
GDPpc	367,474.83	245,638.24	0.67	104,458.68	990,778.75
PublicExpendpc	6,882.45	3,796.43	0.55	2,454.81	17,866.43
hExpendassign	1.13	0.63	0.55	0.40	2.94
bedspc14	4.75	1.34	0.28	3.18	7.76
physicianspc*	37.04	15.68	0.42	21.45	87.44
%pediatricians*	11.82	2.38	0.20	8.22	15.52
Urbanization rate	59.00	20.64	0.35	29.65	100.00
%pop14	27.88	4.75	0.17	20.53	36.44
Year 2018
Infant mortality	8.10	1.71	0.21	5.55	10.81
Under-5 child mortality	10.06	1.90	0.19	7.25	13.07
GDPpc	876,913.90	645,744.67	0.74	299,565.31	2,883,026.00
PublicExpendpc	13,778.60	3,267.19	0.24	9,900.68	23,919.08
hExpendassign	0.93	0.22	0.24	0.67	1.61
bedspc14	3.83	1.07	0.28	2.36	5.97
physicianspc	39.24	15.60	0.40	23.62	79.76
%pediatricians	6.78	1.04	0.15	5.25	9.49
Urbanization rate	57.84	20.74	0.36	23.02	100.00
%pop14	27.43	5.25	0.19	20.15	36.00

*Data for 2003

Table 2. GMM estimation results for explaining infant mortality, time dummies and regional-trends included

	(1)	(2)	(3)	(4)
gdppc	−0.040	−0.084**	−0.093***	−0.070
	(0.026)	(0.040)	(0.035)	(0.053)
Public expenditure pc	−0.037
	(0.122)
% public health exp./% of population)		0.194*	−0.891***	−1.084*
		(0.109)	(0.318)	(0.636)
% public health exp./% of population * L.Infant mortality			0.313***	0.390*
			(0.106)	(0.216)
Pediatric beds/pop $<$ 14				−0.002
				(0.113)
Physicians pc				−0.158
				(0.151)
Pediatricians/physicians				−0.151
				(0.110)
% Female edu (18–22)	0.014	0.059	0.056	0.038
	(0.034)	(0.039)	(0.054)	(0.062)
Water	0.022	0.038	0.069	0.143
	(0.055)	(0.086)	(0.071)	(0.241)
Sanitation pc	−0.017	−0.022	−0.017	−0.028
	(0.018)	(0.021)	(0.019)	(0.018)
Urbanization rate	0.100	0.081	0.065	0.013
	(0.077)	(0.080)	(0.058)	(0.150)
% of pop younger than 14	0.252**	0.415***	0.469***	0.595***
	(0.104)	(0.149)	(0.138)	(0.206)
L.infant mortality	0.656***	0.305**	0.337***	0.388***
	(0.105)	(0.127)	(0.119)	(0.122)
Instruments	47.000	47.000	48.000	58.000
AR(1) (p-values)	0.004	0.000	0.001	0.001
AR(2) (p-values)	0.115	0.109	0.176	0.234
Hansen (p-values)	1.000	1.000	1.000	1.000
Observations	288	288	288	271

Notes: Coefficient estimates and standard errors in brackets. Significance levels: *** p $<$ 0.01 ** p $<$ 0.05 * p $<$ 0.10. Year dummies and time-trends included. Standard errors robust to heteroskedasticity and serial correlation within panels. Lower case variables are in logarithms

Table 3. GMM estimation results for explaining under-5 child mortality, time dummies and regional-trends included

	(1)	(2)	(3)	(4)
gdppc	−0.099***	−0.114***	−0.109***	−0.087*
	(0.018)	(0.025)	(0.026)	(0.049)
Public expenditure pc	0.124*
	(0.067)
% public health exp./% of population)		0.163**	−0.346	−1.050
		(0.070)	(0.330)	(0.689)
% public health exp./% of population * L.Infant mortality			0.132	0.369*
			(0.106)	(0.222)
Pediatric beds/pop $<$ 14				0.068
				(0.086)
Physicians pc				−0.306*
				(0.166)
Pediatricians/physicians				−0.230**
				(0.096)
% Female edu(18–22)	0.014	0.022	0.021	0.010
	(0.014)	(0.021)	(0.027)	(0.068)
Water	0.004	−0.003	0.004	0.103
	(0.047)	(0.061)	(0.056)	(0.280)
Sanitation pc	−0.013	−0.003	0.002	−0.004
	(0.016)	(0.020)	(0.020)	(0.023)
Urbanization rate	0.030	0.034	0.039	0.010
	(0.058)	(0.071)	(0.061)	(0.135)
% of pop younger than 14	0.227***	0.281***	0.301***	0.610***
	(0.068)	(0.096)	(0.099)	(0.207)
L.child mortality	0.693***	0.547***	0.560***	0.415***
	(0.075)	(0.083)	(0.081)	(0.098)
Instruments	47.000	47.000	48.000	58.000
AR(1) (p-values)	0.005	0.002	0.001	0.002
AR(2) (p-values)	0.268	0.273	0.275	0.569
Hansen (p-values)	1.000	1.000	1.000	1.000
Observations	289	289	289	271

Notes: Coefficient estimates and standard errors in brackets. Significance levels: *** p $<$ 0.01 ** p $<$ 0.05 * p $<$ 0.10. Year dummies and time-trends included. Standard errors robust to heteroskedasticity and serial correlation within panels Lower case variables are in logarithms

Figure 3. Relationship between government health budget regional distribution and infant mortality ratio of previous year.

Table A1. Definitions of indicators

Indicator	Definition	Source
Infant mortality rate	Number of infant deaths by per 1,000 live births	Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan
Children under-5 mortality rate	Number of death among children before the age of 5 years per 1,000 live births. It is actually the probability per 1,000 that a newborn baby will die before reaching age of 5	Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan
GDP per capita at prices of 2010	Real gross domestic product by production approach divide by total population. We have used the implicit GDP deflator to transform the GDP at current prices into GDP at constant prices of 2010	Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan
Share of population under 14 years old	Population is provided with different groups disaggregation in different periods. Data has been aggregated into children under 14 to calculate the ratio	Agency for Strategic planning and reforms of the Republic of Kazakhstan & Bureau of National statistics
Urbanization rate	Using the population data as in previous indicator we have aggregate to calculate the urban population and divide it by the total to get the urbanization rate	Agency for Strategic planning and reforms of the Republic of Kazakhstan & Bureau of National statistics
Pediatric beds per children under 14	Number of hospital beds for children divided by children under 14 per 10,000 children	Committee on Statistics of the Ministry of National Economy of the Republic of Kazakhstan
Share of Pediatricians	Number of pediatricians (including neonatologists) divide by number of physicians (including all specialities)	www.medinfo.kz

Table A2. GMM estimation results for explaining infant mortality

	(1)	(2)	(3)	(4)
gdppc	−0.008	−0.027*	−0.028*	−0.025*
	(0.011)	(0.015)	(0.015)	(0.014)
Public expenditure pc	−0.112***
	(0.025)
% public health exp./% of population)		−0.021	−0.097	−0.076
		(0.019)	(0.251)	(0.316)
% public health exp./% of population * L.Infant mortality			0.026	0.028
			(0.084)	(0.107)
Pediatric beds/pop$<$ 14				0.023
				(0.046)
Physicians pc				−0.125**
				(0.057)
Pediatricians/physicians				0.015
				(0.031)
% Female edu(18–22)	0.014	0.000	0.001	0.031
	(0.016)	(0.018)	(0.021)	(0.029)
Water	−0.070*	−0.056	−0.056	−0.044
	(0.041)	(0.036)	(0.038)	(0.045)
Sanitation pc	−0.005	−0.009	−0.010	−0.008
	(0.006)	(0.009)	(0.009)	(0.009)
Urbanization rate	0.082*	0.087**	0.087*	0.132**
	(0.043)	(0.043)	(0.045)	(0.058)
% of pop younger than 14	0.043	0.064*	0.064*	0.095
	(0.038)	(0.038)	(0.038)	(0.072)
L.infant mortality	0.894***	0.931***	0.934***	0.909***
	(0.023)	(0.017)	(0.014)	(0.026)
Constant	1.099***	0.087	0.077	0.055
	(0.287)	(0.230)	(0.231)	(0.302)
Instruments	12.000	12.000	16.000	15.000
AR(1) (p-values)	0.001	0.002	0.002	0.002
AR(2) (p-values)	0.133	0.146	0.147	0.122
Hansen (p-values)	0.030	0.012	0.053	0.039
Observations	288	288	288	271

Notes: Coefficient estimates and standard errors in brackets. Significance levels: *** p $<$ 0.01 ** p $<$ 0.05 * p $<$ 0.10. Standard errors robust to heteroskedasticity and serial correlation within panels. Lower case variables are in logarithms

Table A3. GMM estimation results for explaining under-5 child mortality

	(1)	(2)	(3)	(4)
gdppc	−0.012	−0.024*	−0.023*	−0.022*
	(0.011)	(0.014)	(0.014)	(0.012)
Public expenditure pc	−0.070**
	(0.027)
% public health exp./% of population)		−0.003	0.074	0.056
		(0.026)	(0.242)	(0.277)
% public health exp./% of population * L.Infant mortality			−0.025	−0.010
			(0.079)	(0.092)
Pediatric beds/pop $<$ 14				0.030
				(0.034)
Physicians pc				−0.116**
				(0.049)
Pediatricians/physicians				0.024
				(0.030)
% Female edu (18–22)	0.014	0.007	0.006	0.025
	(0.016)	(0.018)	(0.019)	(0.030)
Water	−0.066*	−0.054*	−0.052*	−0.024
	(0.034)	(0.030)	(0.031)	(0.036)
Sanitation pc	−0.001	−0.004	−0.004	−0.003
	(0.006)	(0.008)	(0.009)	(0.008)
Urbanization rate	0.064	0.062	0.059	0.098*
	(0.040)	(0.044)	(0.044)	(0.054)
% of pop younger than 14	0.051	0.060*	0.059*	0.095*
	(0.031)	(0.032)	(0.033)	(0.053)
L.child mortality	0.901***	0.927***	0.926***	0.903***
	(0.023)	(0.017)	(0.013)	(0.028)
Constant	0.816***	0.185	0.187	0.097
	(0.289)	(0.225)	(0.223)	(0.238)
Instruments	12.000	12.000	16.000	15.000
AR(1) (p-values)	0.002	0.002	0.002	0.003
AR(2) (p-values)	0.255	0.272	0.263	0.231
Hansen (p-values)	0.057	0.024	0.093	0.058
Observations	289	289	289	271

Notes: Coefficient estimates and standard errors in brackets. Significance levels: *** p $<$ 0.01 ** p $<$ 0.05 * p $<$ 0.10. Standard errors robust to heteroskedasticity and serial correlation within panels. Lower case variables are in logarithms

Figure A1. Infant mortality corrected.

Figure A2. Under-5 child mortality corrected.

Figure A3. Relationship between government health budget regional distribution and under-5 child mortality ratio of previous year.