HomeJCARM Vol 1, Issue 7 Article
Original Research Article

Interactive Effects of Health Expenditure and Income Inequality on Under-five Mortality in Sub-Saharan Africa

Alekeu Taye, Idowu Daniel Onisanwa, Ali Madina Dankumo

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Alekeu Taye Corresponding Author

Department of Economics and Development Studies, Federal University, Kashere, Gombe State, Nigeria.

Correspondence: alekeutaye@gmail.com

Received
07 Aug 2026
Published
10 Sep 2026

Abstract

This study examines the interactive effects of health expenditure and income inequality on under-five mortality in Sub-Saharan Africa from 2000 to 2023 using a Generalized Method of Moments (GMM) approach. Utilizing panel data from the World Bank (2025), child mortality is measured per thousand live births, health expenditure is categorized into public and private components, and income inequality is captured via the Gini coefficient. Empirical results indicate that domestic public health expenditure has a negative but statistically insignificant direct effect on under-five mortality, whereas domestic private health expenditure shows a significant negative effect. Conversely, income inequality significantly increases child mortality. Notably, the interaction between public health expenditure and income inequality is negative and statistically significant, demonstrating that equitable public healthcare financing helps mitigate the adverse health impacts of income disparities. In contrast, the interaction between private health spending and income inequality is positive and statistically significant. The study concludes that expanding equitable public health spending and addressing socio-economic inequality are essential strategies for improving child survival outcomes across the region.

Keywords: Under-five Mortality, Health Expenditure and Income Inequality

How to Cite

APA

Taye, A., Onisanwa, I. D., & Dankumo, A. M. (2026). Interactive Effects of Health Expenditure and Income Inequality on Under-five Mortality in Sub-Saharan Africa. Journal of Contemporary Academic Research and Methodologies, 1(7). https://doi.org/10.5281/zenodo.22683728

MLA

Taye, Alekeu, Idowu Daniel Onisanwa, and Ali Madina Dankumo. "Interactive Effects of Health Expenditure and Income Inequality on Under-five Mortality in Sub-Saharan Africa." Journal of Contemporary Academic Research and Methodologies, vol. 1, no. 7, 2026. DOI: https://doi.org/10.5281/zenodo.22683728

Chicago

Taye, Alekeu, Idowu Daniel Onisanwa, and Ali Madina Dankumo. "Interactive Effects of Health Expenditure and Income Inequality on Under-five Mortality in Sub-Saharan Africa." Journal of Contemporary Academic Research and Methodologies 1, no. 7 (2026). https://doi.org/10.5281/zenodo.22683728

References

Adebowale A.A., & Onisanwa I.D, (2024). Effect of Health Expenditure on Health Outcomes in Sub- Saharan Africa. Gusau International Journal of Management and Social Sciences, 7 (3), 152–175. Agbatogun K, K., Lawal N, A., & Balogun O, S, (2025). Income inequality, out-of-pocket health expenditure and health outcome in selected African countries. Journal of management and social sciences 10(1), 1-16 Antonio S, Daniel A. C, and Oscar J. M, Patricia S, & Pablo D. (2024). Income inequality as adeterminant of neonatal mortality in the Americas during 2000–2019: implications for the attainment of Sustainable Development Goal target 3.2. International Journal for Equity in Health (13)6 https://doi.org/10.1186/s12939-024-02157-9 Arthur, E., & Oaikhenan, H.E. (2017). The Effects of Health Expenditure on Health Outcomes in Sub-Saharan Africa (SSA). African Development Rev. 29(2), 524-536. Amy E., & Daniel, M. (2020) state- and country- level income inequality, and infant mortality in the USA 2010: A cohort study. International journal of public health 65(40) 769-780 Bokhari, F. A. S., Gai, Y., & Gottret, P. (2007). Government health expenditures and health outcomes. Health Economics, 16(3), 257–273. https://doi.org/10.1002/hec.1157 Dieleman, J. L., Templin, T., Sadat, N., Reidy, P., Chapin, A., Foreman, K., … Murray, C. J. L. (2016). National spending on health by source for 184 countries between 2013 and 2040. The Lancet, 387(10037), 2521–2535. Gupta, S., Verhoeven, M., & Tiongson, E. (2003). Public spending on health care and the poor. Health Economics, 12(8), 685–696. https://doi.org/10.1002/hec.759 Jamshaid U, RehmanI, Khalil A, & Javeria S. (2023). Income Inequality and Public Health Status: The Role of Government Expenditures of Pakistan Journal of Asian Development Studies (12)3 Malderen, C., Amouzou, A., Barros, A. J. D., Masquelier, B., Van Oyen, H., & Speybroeck, N. (2019). Socioeconomic factors contributing to under-five mortality in sub-Saharan Africa: A decomposition analysis. BMC Public Health, 19(1), 760. https://doi.org/10.1186/s12889-019-7111-8 Novignon, J., Olakojo, S. A., & Nonvignon, J. (2012). The effects of public and private health care expenditure on health status in sub-Saharan Africa. Health Economics Review, 2(1), 22 OECD. (2015). In it together: Why less inequality benefits all. OECD Publishing. Odusanya, I. A., & Akinlo, A. E. (2021). Income inequality and population health in Sub-Saharan Africa: A test of income inequality-health hypothesis. Journal of Population and Social Studies, 29, 235–254. https://doi.org/10.25133/JPSSv292021.015 Oluwaseun A, S, & Onisanwa I, D. (2024) Income inequality and health outcome in Nigeria. Journal of Economics and Allied Research 9(3) Onisanwa, I. D., & Audi, Y. (2024). Health Expenditure and Child Health Outcomes in Sub-Saharan Africa. International Journal of Finance, Insurance and Risk Management,14(4), 37-57. Orach, C. G., & Garimoi, C. O. (2009). Health equity: Challenges in low income countries. African Health Sciences, 9(Suppl 2), S49–S51. Ouedraogo, A. G., et al. (2020). Health expenditure and child mortality in Sub-Saharan Africa. Journal of African Development, 22(1), 45–67. Piketty, T. (2014). Capital in the twenty-first century. Harvard University Press.Rajkumar, A. S., & Swaroop, V. (2008). Public spending and outcomes: Does governance matter? Journal of Development Economics, 86(1), 96–111. Ray, D., & Linden, M. (2020). Health expenditure, longevity, and child mortality: dynamic panel data approach with global data. International Journal of Health Economics and Management, 20(1), 99–119. https://doi.org/10.1007/s10754- 019-09272-z Sibanda, K., Qoko, A., & Gonese, D. (2024). Health expenditure, institutional quality, and under-five mortality in Sub-Saharan African countries. International Journal of Environmental Research and Public Health, 21(3), 333. https://doi.org/10.3390/ijerph21030333 Stiglitz, J. E. (2012). The price of inequality. W. W. Norton & Company. Wilkinson, R. G., & Pickett, K. (2009). The spirit level: Why more equal societies almost always do better. Allen Lane. United Nations Children’s Fund (UNICEF). (2023). Levels & trends in child mortality: Report 2023. UNICEF. UNICEF. (2022). Levels and trends in child mortality. United Nations Children’s Fund. World Bank. (2023). World development indicators. World Bank Publications World Bank. (2023). World development indicators: Under-five mortality rate. World Bank Group. World Health Organization (WHO). (2021). Children: Improving survival and well-being. WHO. World Health Organization. (2023). Levels and trends in child mortality 2023: Estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UN IGME). https://www.who.int/publications/i/item/9789240074328 World Health Organization. (2020). World Health Statistics 2020. WHO. World Health Organization. (2020). Global spending on health: Weathering the storm. WHO Press United Nations Children's Fund. (2021). Levels and trends in child mortality. UNICEF.
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ISSN 3139-7247
Tracking ID JCARM_AUG_26_022
Article No. 005
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Article Info
Journal JCARM
Volume Vol 1, No 7
Year 2026
Type Original Research Article
Licence CC BY-NC-SA 4.0
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