Health System Determinants of Infant, Child and Maternal Mortality: A Cross-Sectional Study of UN Member Countries

Objective:Few studies have examined the link between health system strength and important public healthoutcomes across nations. We examined the association between health system indicators and mortality rates.Methods:We used mixed effects linear regression models to investigate the strength of association betweenoutcome and explanatory variables, while accounting for geographic clustering of countries. We modelled infantmortality rate (IMR), child mortality rate (CMR), and maternal mortality rate (MMR) using 13 explanatory variables asoutlined by the World Health Organization.Results:Significant protective health system determinants related to IMR included higher physician density(adjusted rate ratio [aRR] 0.81; 95% Confidence Interval [CI] 0.71-0.91), higher sustainable access to water andsanitation (aRR 0.85; 95% CI 0.78-0.93), and having a less corrupt government (aRR 0.57; 95% CI 0.40-0.80). Out-ofpocketexpenditures on health (aRR 1.29; 95% CI 1.03-1.62) were a risk factor. The same four variables weresignificantly related to CMR after controlling for other variables. Protective determinants of MMR included access towater and sanitation (aRR 0.88; 95% CI 0.82-0.94), having a less corrupt government (aRR 0.49; 95%; CI 0.36-0.66),and higher total expenditures on health per capita (aRR 0.84; 95% CI 0.77-0.92). Higher fertility rates (aRR 2.85; 95%CI: 2.02-4.00) were found to be a significant risk factor for MMR.Conclusion:Several key measures of a health system predict mortality in infants, children, and maternal mortalityrates at the national level. Improving access to water and sanitation and reducing corruption within the healthsector should become priorities.