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Wealthiest Is Not Always Healthiest: What Explains Differences in Child Mortality in West Africa?
Authors: Amy Ickowitz
Source: Journal of African Economies , Vol. 0, number 0, pp. 1–36, First published online: September 20, 2011, doi: 10.1093/jae/ejr035
Topic(s): Childhood mortality
Children under five
Infant mortality
Wealth Index
Country: Africa
  Multiple African Countries
  Cote D'Ivoire
  Burkina Faso
Published: SEP 2011
Abstract: Abstract Ghana has the lowest under-five mortality rate in West Africa. Understanding why Ghana’s child mortality rate is lower than in neighbouring countries may offer useful insights for other developing countries that are trying to improve child health. This paper explores whether Ghana’s lower mortality rate is mostly a result of greater household wealth, better implementation of national health policies, or more favourable geography. The paper uses micro level data for children under five to examine relative child mortality risk between Ghana and each of its three immediate neighbours—Burkina Faso, the Ivory Coast and Togo. A Cox proportional hazards model is used to test which of the three ‘contenders’—health policy, wealth or geography—best explains Ghana’s mortality advantage. The results of the analysis indicate that wealth variables are not able to explain any of the child mortality variation between Ghana and its neighbours. Geography and health policy variables each explain about 40% of the mortality gap between Ghana and Burkina Faso. Health policy differences alone are able to explain about 70% of the child mortality gap between Ghana and the Ivory Coast. These results suggest that even poor countries that have been ‘cursed’ by bad geography can potentially improve development outcomes and save children’s lives.