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Autonomy, health expenditures and development: A cross-national analysis of infant and child mortality

Jamie Sommer (Department of Political Science, Stockholm University, Stockholm, Sweden)

International Journal of Development Issues

ISSN: 1446-8956

Article publication date: 12 March 2019

Issue publication date: 24 June 2019




State capacity for development is decomposed into two broad dimensions, intrinsic and extrinsic. The former concerns the state’s cohesiveness as a strategic actor, which encompasses the ability of the state to formulate and implement policy in a coherent fashion, and the latter is the state’s ability to extract and redistribute resources. Diverging from previous studies, this paper aims to consider how these intrinsic and extrinsic factors interact to increase health cross-nationally.


This study provides a framework for understanding how domestic and international state autonomy in policy decisions improves the effectiveness of health spending at achieving its intended outcomes. Using two-way fixed effects regression models for a sample of 89 low and middle-income nations from 1996-2012, the author tests the claim that health expenditures reduce infant and child mortality more in nations with higher levels of international and domestic autonomy rather than those with lower levels.


The author finds evidence that supports the theoretical perspective that state autonomy in international and domestic policy, through cohesion, legitimacy and local insight, improves the effectiveness of health expenditures at reducing infant and child mortality.

Research limitations/implications

The data only exist for 89 nations and from 1996 to 2012. In addition, the independent variables of interest that measure autonomy are not direct measures but instead indices.


The health and development of a nation’s citizenry largely depends on prioritizing expenditures in health. This research considers under what conditions nations can better prioritize health expenditures.



Sommer, J. (2019), "Autonomy, health expenditures and development: A cross-national analysis of infant and child mortality", International Journal of Development Issues, Vol. 18 No. 2, pp. 138-159.



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