A new openaccess article in Health Policy and Planning by L.E. Nanziri, Judith Kabajulizi, and P.T. Gbahabo examines how migrant remittances shape public health spending across 53 African countries (1990–2022). Using recent data and a politicaleconomy lens, the study revisits the notion that private inflows can displace government provision—especially where governance is weak.
Methodologically, the authors deploy a smoothed instrumental variables quantile regression (SIVQR), instrumenting remittances with hostcountry GDP growth along known remittance corridors. This captures heterogeneous effects across income quantiles and regime types while addressing endogeneity.
Findings are nuanced. Remittances, on average, increase public health expenditure; however, this positive effect turns into a nonlinear crowdout in the presence of varied political regimes—declines of one to three percentage points across quantiles when democracy interacts with remittance flows. Autocratic tendencies limit legislators’ and citizens’ power to negotiate health budgets. Notably, even major health shocks (Ebola; COVID19) did not consistently shift public health spending in low and middleincome countries; significant increases appeared mainly among higherincome countries.
The transmission mechanism is indirect: remittances boost household consumption and, in upper quantiles, private investment—raising tax revenues (e.g., VAT) that can expand fiscal space for health. Policy implications include (i) treating remittances as debtfree budget support; (ii) adopting adaptive health budgeting responsive to remittance trends; and (iii) leveraging structured diaspora partnerships (e.g., cofunding local health projects) rather than taxing remittance withdrawals, which can drive flows into informal channels. Countries receiving large remittance volumes can strategically complement public health budgets and advance universal health coverage goals.
Citation: Nanziri L.E., Kabajulizi J., & Gbahabo P.T. (2025). Remittances, political economy and public health expenditure: evidence from Africa. Health Policy and Planning. DOI: 10.1093/heapol/czaf089 (CC BY 4.0).