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72 Fighting the Diseases of Poverty
health and education spending and urbanization are controlled for,
but remains significant.
In measuring the impact of corruption on the effectiveness of
health spending Rajkumar and Swaroop (2002) analyze data for
1990 and 1997 controlling for GDP per capita, female educational
attainment, ethno-linguistic fractionalization, urbanization among
other factors, and find that the effectiveness of public health
spending in reducing child mortality hinges on the integrity rating
(1–5 range based on level of perceived corruption), with higher
integrity associated with reduced mortality. Poor governance may
help to explain the inconclusive findings of Filmer and Pritchett
(1999) on the lack of association between public health expenditures
and infant and child mortality.
Wagstaff and Claeson (2005) extend these analyses further and
use more recent data. They find that spending reduces under 5 mortality,
but only where governance, as measured by the World Bank’s
CPIA score (Country Policy and Institutional Assessment measure
that is scored between 1–5 depending on performance, part of
which regards corruption and governance), is sound (a CPIA above
3.25). This study specifically explores the implications of additional
spending for reaching the MDGs, and concludes that more spending
in medium and low CPIA countries would not be expected to reduce
child mortality, and that per capita income growth offers a better
investment if mortality declines are the objective.
Because child mortality rates are measured with substantial
error, especially in the poorest countries, these results need to be
taken with caution. The uncertainty of the direction of causality
introduces further limitations in the interpretations of the results.
Cross-country regressions are hard to interpret in any event, but as
an aggregate assessment they provide general guidance on the relevance
of corruption and other factors in affecting health outcomes
in developing countries. The inability of country level analysis to
elucidate specific country problems leads to the subsequent section
that addresses these issues, complementing this introductory look
at the correlates of health outcomes.