ABSTRACT. Using nationally representative household sample survey, census, and state financial data, this analysis examines the relationship between child health and per capita health spending in South Sudan. The nexus between public health spending and health outcomes lends insights into state effectiveness in service delivery. We exploit this exogenous connection using the multilevel mixed-effects model that accounts for intra-cluster association. This is a longitudinal or panel data estimation strategy that simultaneously estimates both fixed- and random effects. Net of background variables, we find that a percent increase in per capita health spending increases early age mortality by 31 percent among infants and 24 percent among children under the age of five. The estimates are, however, statistically insignificant, suggesting that more generally, there are no health returns to health investment in South Sudan. There is no evidence of state influencing public health spending effectiveness. However, urban-spending interaction term significantly increases mortality; this is statistically significant and implies mortality selection. These results are not surprising and complement the prevailing knowledge that health spending is often ineffective in contexts immersed in poor governance, corruption, aid misalignment, and institutional weakness. Thus, improved governance and enforcement of robust monitoring and accountability measures in social services provision may make public health investment more effective in the country. While South Sudan implements the Agreement on the Resolution of Conflict in South Sudan (ARCISS), foreign aid needs a proper realignment to support recovery priorities, with commitment to service delivery as a lead constituent of its fundamental objectives. pp. 207–243

Keywords: child health; early age mortality; demography; South Sudan; state effectiveness; health spending; multilevel mixed-effects

How to cite: Mayai, Augustino Ting (2016), “The Impact of Public Spending on Infant and Under-Five Health in South Sudan,” American Journal of Medical Research 3(1): 207–243.

Received 2 February 2016 • Received in revised form 6 March 2016
Accepted 6 March 2016 • Available online 25 March 2016


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Research Department,
The Sudd Institute;
School of Public Service,
The University of Juba

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