Institutional qualities, health development assistance, and population health: Evidence from African countries

Abstract

This study examines how institutional qualities influence population health across the region over an extended period, addressing the limited empirical evidence on the institutional determinants of health outcomes. The research focuses on the ways governance structures shape life expectancy and infant mortality, thereby filling a gap in understanding the indirect but foundational role of institutional environments in public health. Using Generalized Method of Moments and Random Effect estimation techniques, the analysis evaluates the effects of control of corruption, government effectiveness, rule of law, and regulatory quality on two central indicators of population health. Although some institutional variables exhibited unexpected directional relationships with life expectancy and infant mortality, their statistical relevance was inconsistent. By contrast, rule of law and regulatory quality showed positive and significant associations with improved health outcomes, highlighting the importance of legal stability and regulatory soundness in strengthening public health performance. Overall, the findings suggest that improvements in institutional conditions may generate more sustainable health gains than relying solely on increases in health development assistance. The study underscores the need for policy approaches that prioritize governance reforms as a complement to traditional health sector investments.

Keywords: Governance; health outcomes; institutional quality; public policy; sustainable development