Roughly 95 percent of cross-national variation in child or infant mortality can be explained by a country's per capita income, the distribution of income, the extent of women's education, the level of ethnic fragmentation, and the predominant religion. Public spending on health has relatively little impact.
Filmer and Pritchett use cross-national data to examine the impact on child (under 5) and infant mortality of both nonhealth (economic, cultural, and educational) factors and public spending on health. They come up with two striking findings:
The estimates imply that for a developing country at average income levels, actual public spending per child death averted is $50,000 to $100,000. This contrasts markedly with a typical range of estimates for the cost-effectiveness of medical interventions to avert the main causes of child mortality of $10 to $4,000.
They outline three possible explanations for this divergence between the actual and apparent potential of public spending: the allocation of public spending, the net impact of additional public supply, and public sector efficacy.
This paper—a product of the Development Research Group—is part of a larger effort in the group to investigate the impact of health sector policies. The study was funded by the Bank's Research Support Budget under the research Project "Primary Health Care: A Critical Evaluation" (RPO 680-29). Copies of this paper are available free from the World Bank, 1818 H Street NW, Washington, DC 20433. Please contact Sheila Fallon, room MC3-638, telephone 202-473-8009, fax 202-522-1153, Internet address sfallon@worldbank.org. (41 pages)
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