Political economy of health in the Southern African Development Community(SADC) region:The effect of political instability on health outcomes and expenditure

This dissertation studies the effect of political stability on health outcomes and expenditure in the SADC region. The health outcomes under investigation are life expectancy at birth, maternal mortality ratio, infant mortality rate and HIV incidence. Health expenditure is captured as the percentage of total government expenditure that is allocated to public health. The study conducts a literature review on previous studies that examine these relationships, conduct exploratory data analysis and conduct empirical estimations using two measures of political stability: International Country Risk Guide’s Political Risk Services index and the World Bank’s World Development Indicator index. Additionally, further investigation is made into the effect that a country’s level of democracy has on health outcomes and public health expenditure. The empirical estimations involve a panel dataset containing 11 SADC countries over a 20 year period from 1996 to 2015. The results confirm the statistical and economic significance of political stability on all the health outcomes under investigation and on public health expenditure when controlling for heteroscedasticity and autocorrelation. Holding all else constant, a one point increase in the political stability variable is associated with an increase of 0.19% for life expectancy, a decrease of 1.39% in maternal mortality, a decrease of 2.01% in infant mortality, an increase in HIV incidence of 3.48% and an increase in public health expenditure of 2.03%, when using the International Country Risk Guide’s Political Risk Services index (ICRG). Political instability in the SADC region is characterized by destruction of social infrastructure including hospitals and roads in Angola and the Democratic Republic of Congo and lack of resources for adequate healthcare in countries such as Zimbabwe, Zambia and Malawi. Both mechanisms result in poor health outcomes in a given country in the region. Subsequently, countries like South Africa receiving refugees from politically unstable countries in the region also suffer from an overload on their health system which means resources allocated to the health sector are no longer adequate to meet the increased demand. When using the World Bank’s World Development Indicators (WB), holding all else constant, infant mortality decreases by 0.27% and HIV incidence increases by 0.40% when political stability increases by one point. The policy recommendation is to ensure strategic governance is in place to ensure that the health sector is not affected by political instability