Official Development Assistance, External Public Debt and Domestic Health Financing in Low- and Middle-Income Countries: Panel Data Analysis and Case

Study in Senegal.
Motivation: Nearly US$ 40 billion are disbursed annually as Development Assistance for Health (DAH) to Low- and Middle-Income Countries (LMICs). At the same time, LMIC governments repay nearly US$ 300 billion of public debt annually to High-Income Country (HIC) creditors. It is poorly understood how these positive and negative funding flows in LMICs affect countries' own public health investments. It is further nearly an unexplored question, how these flows affect the composition of health financing in LMICs, i.e. the reliance on public vs. private health financing. In order for the UK's and other OECD countries' international development policies to achieve their objectives in tackling global health threats and challenges and promoting the health and wellbeing of the world's poorest through strong domestic health systems, a deeper understanding of the health financing effects of these funding flows is needed. Objectives: Objective 1: To explore the effects of DAH and public external debt on domestic government health expenditure (GHE-S) in LMICs. Objective 2: To explore the effects of DAH and public external debt on out-of-pocket payments (OOP) for health services and voluntary health care payment scheme (VHPS) expenditures in LMICs. Objective 3: To explore how international official donors and creditors, and the funds received from and paid to them, have influenced domestic health financing in Senegal. Methods: My methodological approach to the above questions will be both quantitative and qualitative. I will combine a number of large publicly available multi-country datasets and analyse them using advanced econometric methods including panel data analysis performed in STATA. To inform this analysis and explore potential underlying causative mechanisms, I will also conduct interviews with stakeholders and perform a document review at stakeholder institutions in Senegal.
Expected Impact: With this research I aim to increase our understanding of how international official funding flows affect domestic health financing in LMICs. I aim to be able to propose evidence-based suggestions for how to avoid or mitigate any identified effects that may hamper the transition of developing economies towards strengthened, equitable domestic health financing. This will be a key step towards achieving the health Sustainable Development Goals (SDGs), Universal Health Coverage (UHC) and the development objectives of donor countries: A healthier, safer and more prosperous world for all. Skills gained during studentship: -I have completed a three-week full-time course in advanced econometrics at the London School of Economics and Political Science (LSE). This has equipped me with state-of-the-art techniques for analysing large country-level datasets. -I have completed a one-day course in semi-structured interviews. -I have audited the 8-week course in qualitative methodologies at LSHTM. - I have reviewed the 10-week ESRC DTP "Core Skills for Doctoral Researchers" course material online. -The topic areas studied throughout my studentship will span health and development economics predominantly at the macroeconomic level, econometrics, global governance, health systems and -policy, statistics, interview- and document review methodology. -I have assessed the ethical aspects of my research and been granted ethics approval. - I have obtained key data collection and management skills. -The case study conducted in Senegal has improved my understanding of public health and development policy mechanisms in these countries, and it has develop my communication and intercultural skills, which has better equipped me for a career in public health and international development (including French language skills). I will disseminate the results of my research in academic journals and at international conferences.