Bangladesh has made significant improvements in the health of women and children and has achieved its Millennium Development Goal (MDG) 4 (to reduce child mortality) and is on track to MDG 5a (to reduce maternal mortality). In 2010, the United Nations recognised Bangladesh for its exceptional progress towards MDG 4 and 5a to reduce child and maternal mortality in the face of many socio-economic challenges. Several factors outside of the health sector have supported reductions in maternal and child mortality. Female education is one of those factors which may have significant effect on the improvements in health outcomes of Bangladesh. In order to investigate deeper into these facts, Bangladesh Institute of Governance and Management (BIGM) has conducted a scientific econometric research assuming that rapid progress in female education may reflect the Bangladeshis' social responsiveness to change towards the improvement of health outcomes. The purpose of that paper was to see how the health outcomes (in case of life expectancy, under-5 mortality and adolescent fertility) are impacted by health expenditure (both public and private), per capita income in presence of overall governance and female education. The paper uses autoregressive distributed lag technique to estimate the models with data ranges from 1990 to 2016 under two different scenarios. Figure 1 shows trend of selected variables over the period 1990 to 2016.
The composite governance issue variable is generated using Principal Component Analysis method, combining all 12 dimensions of International Country Risk Guide.
For the first scenario, individual health outcome (defined in terms of three major indicators, such as Life Expectancy , Under-5 Mortality and Adolescent Fertility were taken as dependent variables. Public and private health expenditure as percentage of GDP, per capita GDP and composite governance issue were taken as independent variables. Female Secondary School enrolment ratio was taken as explanatory proxy variable. It was found that the composite governance issue shows expected positive impact on life expectancy and negative impact on other two health outcomes at 1 per cent level of significance. Female secondary school enrolment ratio provides ambiguous insignificant impact on life expectancy though it shows expected negative impact on under-5 mortality and adolescent fertility at 10 per cent and 1 per cent level of significance, respectively. So it provides statistically significant evidence that female education and female participation in the labour force are actually improving the health outcomes of Bangladesh. Moreover, public health expenditure has significant positive impact on life expectancy at 10 per cent, whereas it has strong negative impact on under-5 mortality and adolescent fertility at 1 per cent level of significance. Private health expenditure has positive impact on life expectancy at 1 per cent and negative impact on other two health outcomes at 10 per cent level of significance. Income level of people is represented by per capita GDP which also provides expected significant impacts on all the three health outcomes.
The effect of public health expenditure augmented governance issue on selected health outcomes was examined in presence of relevant variables in second scenario. It also shows significant positive impact on life expectancy at 5 per cent and strong negative impact on under-5 mortality and adolescent fertility at 10 per cent and 1 per cent level of significance, respectively. Basically, it can be said that 1 per cent increase in public health expenditure augmented governance issue and will lead to 0.15 per cent increase in life expectancy; moreover, it will decrease under-five 5 rate by 11.5 per cent and adolescent fertility rate by 9.7 per cent in the long run. However, female secondary enrolment ratio and per capita GDP shows statistically significant impact on the health outcomes with expected signs. In this case, coefficient of female secondary enrolment ratio statistically improves with improved significance level than previous section. The coefficient of private health expenditure has also shown significant impact on health outcomes with expected signs except on under-5 mortality though insignificant.
Our findings of the study econometrically prove the fact that the rapid improvement of female education has significant positive impact on current health status of Bangladesh. The relationship among the health outcomes and the composite governance issue, female secondary school enrolment ratio and public health expenditure calls for the government to maximise the positive externality of social attitude to change through women empowerment. This female education programme enhances the participation of female in the labour force and indirectly helps to achieve this remarkable achievement in heath sector. However, the governance issues plaguing the health sector needs to be identified and addressed as a priority to improve the efficiency and effectiveness of the public funds and also achieve better health outcomes which will once again enable the country to achieve its health-care goals and agenda outlined in the SDGs. Nevertheless, the increase of health care budget is also necessary as it has significant impact on health outcomes. In that case, public spending on health issue can be increased to ensure Universal Health Coverage goals to reduce the burden of private heath expenditure.
Tahmina Sultana is Research Fellow, Bangladesh Institute of Governance and Management (BIGM).
Faroque Ahmed is Research Associate, BIGM