Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region

Johnbosco Chukwuma Ozigbu; Christopher Ifeanyi Ezekwe

doi:doi:10.11648/j.hep.20251002.15

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Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region

Johnbosco Chukwuma Ozigbu

, Christopher Ifeanyi Ezekwe^*

Published in International Journal of Health Economics and Policy (Volume 10, Issue 2)

Received: 20 April 2025 Accepted: 3 May 2025 Published: 12 June 2025

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Abstract

Motivated by the widening gap in lifespan within and between countries and across age groups, this study quantifies the implications of public health expenditure, out-of-pocket healthcare payments and maternal health conditions such as the prevalence of obesity and anaemia on lifespan inequality among women in five anglophone countries (Ghana, Liberia, Nigeria, Sierra Leone, and The Gambia) and five francophone countries (Senegal, Niger, Mali, Guinea and Togo) in the ECOWAS region. Heterogeneous panel estimation involving mean group (MG) and pooled mean group (PMG) estimators alongside unit root tests and descriptive statistics formed the basis for the analysis. Findings indicate that public health expenditure does not significantly reduce the disparity in lifespan in both the short and long run. This highlights the need for more effective public healthcare financing that will increase healthcare access and prioritise healthcare in reinvestments of the savings from subsidy removal, while mitigating corruption. Further analysis showed that out-of-pocket healthcare payments significantly reduced inequality in the length of life of women in both the short and long run. This highlights the efficacy of out-of-pocket healthcare payments in promoting uniformity in the ages of death of women. However, the findings showed that the prevalence of obesity and anaemia among women worsened the lifespan inequality during the study period. This explains the need to address underlying health conditions in women through healthy diets and regular physical exercise. Given the findings, this study recommends boosting the purchasing power of women for more independent financial decisions to improve equality in their longevity. Again, targeted conditional cash transfers should be provided to vulnerable women to boost their out-of-pocket healthcare payments for a more equal lifespan.

Published in	International Journal of Health Economics and Policy (Volume 10, Issue 2)
DOI	10.11648/j.hep.20251002.15
Page(s)	67-76
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Lifespan Inequality, Health Expenditure, Out-of-pocket Payments, Maternal Health, Women and ECOWAS

References

[1]	Agyemang, C., Kushitor, S. B., Afrifa-Anane, G. F., & de-Graft Aikins, A. (2024). Obesity in Africa: A Silent Public Health Crisis. In Metabolic Syndrome: A Comprehensive Textbook (pp. 47-64). Cham: Springer International Publishing.
[2]	Anwar, A., Hyder, S., Mohamed Nor, N., & Younis, M. (2023). Government health expenditures and health outcome nexus: a study on OECD countries. Frontiers in Public Health, 11, 1123759.
[3]	Ayoya, M. A., Bendech, M. A., Zagré, N. M., & Tchibindat, F. (2012). Maternal anaemia in West and Central Africa: time for urgent action. Public health nutrition, 15(5), 916-927.
[4]	Azam, M., Uddin, I., & Saqib, N. (2023). The determinants of life expectancy and environmental degradation in Pakistan: evidence from ARDL bounds test approach. Environmental Science and Pollution Research, 30(1), 2233-2246.
[5]	Bansal, S., & Jin, Y. (2023). Heterogeneous effects of obesity on life expectancy: a global perspective. Annual Review of Resource Economics, 15(1), 433-554.
[6]	Berger, M. C., & Messer, J. (2002). Public financing of health expenditures, insurance, and health outcomes. Applied Economics, 34(17), 2105-2113.
[7]	Breitung, J. (2001). The local power of some unit root tests for panel data. In Nonstationary panels, panel cointegration, and dynamic panels (pp. 161-177). Emerald Group Publishing Limited.
[8]	Bunyaminu, A., Mohammed, I., Yakubu, I. N., Shani, B., & Abukari, A. L. (2022). The effect of health expenditure on average life expectancy: does government effectiveness play a moderating role?. International Journal of Health Governance, 27(4), 365-377.
[9]	Goodarzi, E, Beiranvand, R, Naemi H, Darvishi, I, & Khazaei Z. (2020). Prevalence of iron deficiency anaemia in Asian female population and human development index (HDI): An ecological study. Obstetrics & Gynecology Science, 63(4): 497-505.
[10]	Guzel, A. E., Arslan, U., & Acaravci, A. (2021). The impact of economic, social, and political globalization and democracy on life expectancy in low-income countries: are sustainable development goals contradictory?. Environment, Development and Sustainability, 23(9), 13508-13525.
[11]	Harris, R. D., & Tzavalis, E. (1999). Inference for unit roots in dynamic panels where the time dimension is fixed. Journal of econometrics, 91(2), 201-226.
[12]	Hausman, J. A. (1978). Specification tests in econometrics. Econometrica: Journal of the econometric society, 1251-1271.
[13]	Im, K. S., Pesaran, M. H., & Shin, Y. (2003). Testing for unit roots in heterogeneous panels. Journal of econometrics, 115(1), 53-74.
[14]	Mawani, M., Ali, S. A., Bano, G., & Ali, S. A. (2016). Iron deficiency anemia among women of reproductive age, an important public health problem: situation analysis. Reproductive System & Sexual Disorders: Current Research., 5(3), 1.
[15]	Mayhew, L., & Smith, D. (2021). An investigation into inequalities in adult lifespan. North American Actuarial Journal, 25(sup1), S545-S565.
[16]	Millman, N., Koethe, J. R., & Erlandson, K. M. (2024). Obesity among women with HIV. Current Opinion in HIV and AIDS, 19(1), 30-34.
[17]	Mulaga, A. N., Kamndaya, M. S., & Masangwi, S. J. (2021). Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi. Plos one, 16(3), e0248752.
[18]	Obrizan, M., & Wehby, G. L. (2018). Health expenditures and global inequalities in longevity. World Development, 101, 28-36.
[19]	Onya, O. R., Uzoigwe, M. C., Ovat, E. O., Abane, O. P., & Osa, I. P. (2024). Public health expenditure, government effectiveness and labour productivity in West Africa. Nurture, 18(1), 55-72.
[20]	Owais, A., Merritt, C., Lee, C., & Bhutta, Z. A. (2021). Anemia among women of reproductive age: an overview of global burden, trends, determinants, and drivers of progress in low-and middle-income countries. Nutrients, 13(8), 2745.
[21]	Pedroni, P. (2007). Social capital, barriers to production and capital shares: implications for the importance of parameter heterogeneity from a nonstationary panel approach. Journal of Applied Econometrics, 22(2), 429-451.
[22]	Pesaran, M. H., & Smith, R. P. (1995). Estimating long-run relationships from dynamic heterogeneous panels. Journal of Econometrics, 68(1), 79-113.
[23]	Pesaran, M. H., Shin, Y., & Smith, R. P. (1999). Pooled mean group estimation of dynamic heterogeneous panels. Journal of the American statistical Association, 94(446), 621-634.
[24]	Raghupathi, V., & Raghupathi, W. (2020). Healthcare expenditure and economic performance: insights from the United States data. Frontiers in public health, 8, 156.
[25]	Rahman, M. M., Rana, R., & Khanam, R. (2022). Determinants of life expectancy in most polluted countries: Exploring the effect of environmental degradation. PloS one, 17(1), e0262802.
[26]	Romer, P. M. (1994). The origins of endogenous growth. Journal of Economic perspectives, 8(1), 3-22.
[27]	Shockley, T., & Burrell, D. N. (2024). Economic, Cultural, Social Determinants of Black Women Obesity. Business Ethics and Leadership, 8(1), 234-245.
[28]	Sultana, S., Hossain, M. E., Khan, M. A., Saha, S. M., Amin, M. R., & Prodhan, M. M. H. (2024). Effects of healthcare spending on public health status: An empirical investigation from Bangladesh. Heliyon, 10(1).
[29]	Teasdale, A. (2025). Voting For More?: Ageing and Health Spending. Age, 20(29), 40-49.
[30]	Vaupel, J. W., Villavicencio, F., & Bergeron-Boucher, M. P. (2021). Demographic perspectives on the rise of longevity. Proceedings of the National Academy of Sciences, 118(9), e2019536118.
[31]	WHO (World Health Organ.). 2021b. Obesity and overweight. Fact Sheet, World Health Organ., Geneva. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
[32]	World Bank (2025). Share of women of reproductive age who have anaemia. Available on: https://ourworldindata.org/grapher/prevalence-of-anemia-in-women-of-reproductive-age-aged-15-29?
[33]	World Health Organization - Global Health Observatory (2024). Share of women who are overweight or obese. Available on: https://ourworldindata.org/grapher/share-of-females-defined-as-overweight?
[34]	World Health Organization (2025). Public healthcare expenditure as a share of GDP. Available on: https://ourworldindata.org/grapher/public-healthcare-spending-share-gdp?
[35]	World Health Organization (2025). Share of out-of-pocket expenditure on healthcare. Available on: https://ourworldindata.org/grapher/share-of-out-of-pocket-expenditure-on-healthcare

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APA Style

Ozigbu, J. C., Ezekwe, C. I. (2025). Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region. International Journal of Health Economics and Policy, 10(2), 67-76. https://doi.org/10.11648/j.hep.20251002.15

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ACS Style

Ozigbu, J. C.; Ezekwe, C. I. Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region. Int. J. Health Econ. Policy 2025, 10(2), 67-76. doi: 10.11648/j.hep.20251002.15

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AMA Style

Ozigbu JC, Ezekwe CI. Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region. Int J Health Econ Policy. 2025;10(2):67-76. doi: 10.11648/j.hep.20251002.15

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@article{10.11648/j.hep.20251002.15,
  author = {Johnbosco Chukwuma Ozigbu and Christopher Ifeanyi Ezekwe},
  title = {Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region
},
  journal = {International Journal of Health Economics and Policy},
  volume = {10},
  number = {2},
  pages = {67-76},
  doi = {10.11648/j.hep.20251002.15},
  url = {https://doi.org/10.11648/j.hep.20251002.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20251002.15},
  abstract = {Motivated by the widening gap in lifespan within and between countries and across age groups, this study quantifies the implications of public health expenditure, out-of-pocket healthcare payments and maternal health conditions such as the prevalence of obesity and anaemia on lifespan inequality among women in five anglophone countries (Ghana, Liberia, Nigeria, Sierra Leone, and The Gambia) and five francophone countries (Senegal, Niger, Mali, Guinea and Togo) in the ECOWAS region. Heterogeneous panel estimation involving mean group (MG) and pooled mean group (PMG) estimators alongside unit root tests and descriptive statistics formed the basis for the analysis. Findings indicate that public health expenditure does not significantly reduce the disparity in lifespan in both the short and long run. This highlights the need for more effective public healthcare financing that will increase healthcare access and prioritise healthcare in reinvestments of the savings from subsidy removal, while mitigating corruption. Further analysis showed that out-of-pocket healthcare payments significantly reduced inequality in the length of life of women in both the short and long run. This highlights the efficacy of out-of-pocket healthcare payments in promoting uniformity in the ages of death of women. However, the findings showed that the prevalence of obesity and anaemia among women worsened the lifespan inequality during the study period. This explains the need to address underlying health conditions in women through healthy diets and regular physical exercise. Given the findings, this study recommends boosting the purchasing power of women for more independent financial decisions to improve equality in their longevity. Again, targeted conditional cash transfers should be provided to vulnerable women to boost their out-of-pocket healthcare payments for a more equal lifespan.
},
 year = {2025}
}

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TY  - JOUR
T1  - Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region

AU  - Johnbosco Chukwuma Ozigbu
AU  - Christopher Ifeanyi Ezekwe
Y1  - 2025/06/12
PY  - 2025
N1  - https://doi.org/10.11648/j.hep.20251002.15
DO  - 10.11648/j.hep.20251002.15
T2  - International Journal of Health Economics and Policy
JF  - International Journal of Health Economics and Policy
JO  - International Journal of Health Economics and Policy
SP  - 67
EP  - 76
PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20251002.15
AB  - Motivated by the widening gap in lifespan within and between countries and across age groups, this study quantifies the implications of public health expenditure, out-of-pocket healthcare payments and maternal health conditions such as the prevalence of obesity and anaemia on lifespan inequality among women in five anglophone countries (Ghana, Liberia, Nigeria, Sierra Leone, and The Gambia) and five francophone countries (Senegal, Niger, Mali, Guinea and Togo) in the ECOWAS region. Heterogeneous panel estimation involving mean group (MG) and pooled mean group (PMG) estimators alongside unit root tests and descriptive statistics formed the basis for the analysis. Findings indicate that public health expenditure does not significantly reduce the disparity in lifespan in both the short and long run. This highlights the need for more effective public healthcare financing that will increase healthcare access and prioritise healthcare in reinvestments of the savings from subsidy removal, while mitigating corruption. Further analysis showed that out-of-pocket healthcare payments significantly reduced inequality in the length of life of women in both the short and long run. This highlights the efficacy of out-of-pocket healthcare payments in promoting uniformity in the ages of death of women. However, the findings showed that the prevalence of obesity and anaemia among women worsened the lifespan inequality during the study period. This explains the need to address underlying health conditions in women through healthy diets and regular physical exercise. Given the findings, this study recommends boosting the purchasing power of women for more independent financial decisions to improve equality in their longevity. Again, targeted conditional cash transfers should be provided to vulnerable women to boost their out-of-pocket healthcare payments for a more equal lifespan.

VL  - 10
IS  - 2
ER  -

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Author Information

Johnbosco Chukwuma Ozigbu

Department of Economics, Rivers State University, Port Harcourt, Nigeria

Contact Email

http://orcid.org/0009-0003-6967-7511
Christopher Ifeanyi Ezekwe

Department of Economics, Rivers State University, Port Harcourt, Nigeria

Contact Email

http://orcid.org/0009-0001-5112-1369

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APA Style

Ozigbu, J. C., Ezekwe, C. I. (2025). Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region. International Journal of Health Economics and Policy, 10(2), 67-76. https://doi.org/10.11648/j.hep.20251002.15

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ACS Style

Ozigbu, J. C.; Ezekwe, C. I. Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region. Int. J. Health Econ. Policy 2025, 10(2), 67-76. doi: 10.11648/j.hep.20251002.15

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AMA Style

Ozigbu JC, Ezekwe CI. Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region. Int J Health Econ Policy. 2025;10(2):67-76. doi: 10.11648/j.hep.20251002.15

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@article{10.11648/j.hep.20251002.15,
  author = {Johnbosco Chukwuma Ozigbu and Christopher Ifeanyi Ezekwe},
  title = {Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region
},
  journal = {International Journal of Health Economics and Policy},
  volume = {10},
  number = {2},
  pages = {67-76},
  doi = {10.11648/j.hep.20251002.15},
  url = {https://doi.org/10.11648/j.hep.20251002.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20251002.15},
  abstract = {Motivated by the widening gap in lifespan within and between countries and across age groups, this study quantifies the implications of public health expenditure, out-of-pocket healthcare payments and maternal health conditions such as the prevalence of obesity and anaemia on lifespan inequality among women in five anglophone countries (Ghana, Liberia, Nigeria, Sierra Leone, and The Gambia) and five francophone countries (Senegal, Niger, Mali, Guinea and Togo) in the ECOWAS region. Heterogeneous panel estimation involving mean group (MG) and pooled mean group (PMG) estimators alongside unit root tests and descriptive statistics formed the basis for the analysis. Findings indicate that public health expenditure does not significantly reduce the disparity in lifespan in both the short and long run. This highlights the need for more effective public healthcare financing that will increase healthcare access and prioritise healthcare in reinvestments of the savings from subsidy removal, while mitigating corruption. Further analysis showed that out-of-pocket healthcare payments significantly reduced inequality in the length of life of women in both the short and long run. This highlights the efficacy of out-of-pocket healthcare payments in promoting uniformity in the ages of death of women. However, the findings showed that the prevalence of obesity and anaemia among women worsened the lifespan inequality during the study period. This explains the need to address underlying health conditions in women through healthy diets and regular physical exercise. Given the findings, this study recommends boosting the purchasing power of women for more independent financial decisions to improve equality in their longevity. Again, targeted conditional cash transfers should be provided to vulnerable women to boost their out-of-pocket healthcare payments for a more equal lifespan.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Rethinking the Dynamics of Healthcare Funding, Maternal Health Status and Lifespan Inequality Among Women in the ECOWAS Region

AU  - Johnbosco Chukwuma Ozigbu
AU  - Christopher Ifeanyi Ezekwe
Y1  - 2025/06/12
PY  - 2025
N1  - https://doi.org/10.11648/j.hep.20251002.15
DO  - 10.11648/j.hep.20251002.15
T2  - International Journal of Health Economics and Policy
JF  - International Journal of Health Economics and Policy
JO  - International Journal of Health Economics and Policy
SP  - 67
EP  - 76
PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20251002.15
AB  - Motivated by the widening gap in lifespan within and between countries and across age groups, this study quantifies the implications of public health expenditure, out-of-pocket healthcare payments and maternal health conditions such as the prevalence of obesity and anaemia on lifespan inequality among women in five anglophone countries (Ghana, Liberia, Nigeria, Sierra Leone, and The Gambia) and five francophone countries (Senegal, Niger, Mali, Guinea and Togo) in the ECOWAS region. Heterogeneous panel estimation involving mean group (MG) and pooled mean group (PMG) estimators alongside unit root tests and descriptive statistics formed the basis for the analysis. Findings indicate that public health expenditure does not significantly reduce the disparity in lifespan in both the short and long run. This highlights the need for more effective public healthcare financing that will increase healthcare access and prioritise healthcare in reinvestments of the savings from subsidy removal, while mitigating corruption. Further analysis showed that out-of-pocket healthcare payments significantly reduced inequality in the length of life of women in both the short and long run. This highlights the efficacy of out-of-pocket healthcare payments in promoting uniformity in the ages of death of women. However, the findings showed that the prevalence of obesity and anaemia among women worsened the lifespan inequality during the study period. This explains the need to address underlying health conditions in women through healthy diets and regular physical exercise. Given the findings, this study recommends boosting the purchasing power of women for more independent financial decisions to improve equality in their longevity. Again, targeted conditional cash transfers should be provided to vulnerable women to boost their out-of-pocket healthcare payments for a more equal lifespan.

VL  - 10
IS  - 2
ER  -

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