178494 Does Governance in Sub-Saharan Africa Affect Health Outcomes

Tuesday, October 28, 2008: 1:10 PM

Sandra J. Winter, PhD, MHA , Department of Family and Community Medicine, University of Kentucky, Lexington, KY

The inability of developing countries to administer simple, low cost treatments for conditions that have been curable for decades is of concern. Despite substantial foreign aid to Africa, health outcomes have declined in recent years. Inadequate governance in African countries may negatively affect health care delivery. An Index of African Governance newly devised by researchers at Harvard University is used to determine if political governance has a statistically significant effect on the burden of disease in Africa. The index comprises a measure for safety and security; rule of law, transparency and corruption; participation and human rights; and sustainable economic development. Other variables which may affect health outcomes are also included in the model.


The data used in this research is from the World Health Organization, the United Nations Development Program, the Mo Ibrahim Foundation and Ethnologue. The population is 45 sub Saharan African countries.


OLS regressions were conducted examining the effect of the independent variables on healthy life expectancy at birth, years of life lost due to disease or injury and disability adjusted life years.


Preliminary data analysis suggests that of the governance variables, rule of law and safety and security are significant. Expenditure, sanitation, access to water, ethnolinguistic fragmentation, alcohol use and number of providers variously have a statistically significant impact on the dependent variables.

Policy Implications

The quality of governance in Africa may be a determinant of health care delivery and outcomes and should be considered along with other variables.

Learning Objectives:
Identify the statistically significant factors that affect health outcomes in Sub-Saharan Africa Identify how political governance affects health outcomes in Sub-Saharan Africa

Keywords: Government, Developing Countries

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was born and educated in Zimbabwe and then spent 17 years living in South Africa. I therefore have first hand experience of the public health challenges facing Africa. More recently I have been enrolled as a PhD student in Public Administration at the University of Kentucky. This program has a strong economic component and in addition, focuses on the role governments play in the administration of various public programs. I am in the health policy track and am particuluraly interested in the relationship between economic development and health outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.