title: Political determinants of progress in the MDGs in Sub-Saharan Africa.
abstract: Sub-Saharan Africa (SSA) lagged furthest behind in achieving targets for the millennium development goals (MDG). We investigate the hypothesis that its slow progress is influenced by political factors. Longitudinal data on three health MDG indicators: under-five mortality, maternal mortality and HIV prevalence rates were collated from 1990 to 2012 in 48 countries. Countries were grouped into geo-political and eco-political groups. Groupings were based on conflict trends in geographical regions and the International Monetary Fund's classification of SSA countries based on gross national income and development assistance respectively. Cumulative progress in each group was derived and main effects tested using ANOVA. Correlation analysis was conducted between political variables - POLITY 2, fragile state index (FSI), voter turnout rates, civil liberty scores (CLS) and the health variables. Our results suggest a significant main effect of eco-political and geo-political groups on some of the health variables. Political conflict as measured by FSI and political participation as measured by CLS were stronger predictors of slow progress in reducing under-five mortality rates and maternal mortality ratios. Our findings highlight the need for further research on political determinants of mortality in SSA. Cohesive effort should focus on strengthening countries' political, economic and social capacities in order to achieve sustainable goals beyond 2015.
authors.affiliation: a Unit for Health Promotion Research , University of Southern Denmark , Esbjerg , Denmark.
authors.forename: Emma
authors.initials: E
authors.lastname: Atti
authors.affiliation: a Unit for Health Promotion Research , University of Southern Denmark , Esbjerg , Denmark.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gulis
mesh_terms: D017954:Africa South of the Sahara; D014943:Global Health; D006040:Goals; D006305:Health Status Indicators; D006801:Humans; D011057:Politics; D011634:Public Health; D064890:Social Determinants of Health
keywords: MDG; Political determinants of health; Sub-Saharan Africa; democracy; public health