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Rural poverty remains high in many developing countries, Ghana inclusive. This has implications for healthcare affordability and utilization, and thus the attainment of universal health coverage. Nonfarm diversification is seen as a means by which rural farm households can increase incomes and smooth consumption including healthcare. The purpose of this paper is to investigate the impact of nonfarm enterprise participation on healthcare expenditure among farm households in rural Ghana.

Using nationally representative household data from the sixth round of the Ghana Living Standards Survey (GLSS 6), the paper employs endogenous switching regression and propensity score matching techniques to account for potential selectivity bias.

Results indicate that households that participate in nonfarm enterprises earn higher incomes and expend more on healthcare. Total household income and region of residence are significant determinants of healthcare expenditure among farm households in rural Ghana. In addition, while in nonfarm enterprise nonparticipating households the marital status of the head of household is important, for participating households the head having at least secondary education significantly influences healthcare expenditure.

Promoting nonfarm activities and hence raising the incomes of households in rural areas of Ghana has the potential of increasing health capital through increased investments in health. It will also positively impact access to and utilization of healthcare and ultimately contribute towards increased farm and non-farm productivity.

Previous studies have only examined the determinants of nonfarm enterprise participation or its impact on household welfare, poverty, inequality, food security and agricultural investments. While evidence abounds on the positive impact of rural nonfarm enterprise participation on household income, which in turn has implications for household health expenditure, the potential positive link between rural nonfarm enterprise participation and household healthcare expenditure remains unexamined.

Equity in access to and use of healthcare resources is a global development agenda. Policymakers’ knowledge of the sources of differences in household healthcare spending is crucial for effective policy. This paper aims to investigate the differences in the determinants of household healthcare expenditure across space and along selected quantiles of healthcare expenditure in Ghana. The determinants of rural-urban healthcare expenditure gap are also explored.

Data was obtained from the sixth round of the Ghana Living Standards Survey (GLSS 6) conducted in 2013. An unconditional quantile regression (UQR) and a decomposition technique based on UQR, adjusted for sample selection bias, were applied.

The results indicate that differences in the determinants of household healthcare expenditure across space and along quantiles are driven by individual-level variables. Besides, the rural-urban health expenditure gap is greatest among households in the lower quantiles and this gap is largely driven by differences in household income per capita and percentage of household members enrolled on health insurance policies.

The findings show that there are differences in the determinants of household health expenditure along with the income distribution, as well as between rural and urban localities, which would call for targeted policies to address these inequalities.

This study aims to estimate the degree and nature of socioeconomic-related inequalities in sexual and reproductive health in Ghana and further assesses causes of these inequalities using decomposition technique. The authors assess the contribution of personal characteristics of the woman including access to health information and health seeking behaviours, household and locational characteristics to inequalities in sexual and reproductive health in Ghana. The study uses data from the three rounds of the Ghana Demographic and Health Survey conducted in 2003, 2008 and 2014.

Two indicators – use of modern contraceptives and intention to use modern contraceptives – are used to measure sexual and reproductive health of sexually active women. A wealth index, based on household ownership of assets, consumer goods and living conditions, is used as a measure of socioeconomic status. The paper estimates a concentration index to the relationship between cumulative health and socioeconomic rank. Paper procedures to apply decomposition techniques to determine the causes of socioeconomic inequalities in health based on a linear health regression model.

The study finds evidence of varying degrees of socioeconomic-related inequalities in sexual and reproductive health indicators. Specifically, the study finds that whilst use of modern contraceptives was concentrated among women in households with high socioeconomic status in 2003 and 2008, modern contraceptive use was prevalent among women in low socioeconomic status households in 2014. Equally, the study finds significant pro-poor inequalities in the intentions to use modern contraceptives in 2003 and 2014. The degree of socioeconomic inequalities in the intentions to use modern contraceptives increased between 2003 and 2014.

There is the lack of evidence on the degree, nature and causes of socioeconomic-related inequalities, which in tend impedes the design and implementation of sexual and reproductive health policies targeted at vulnerable and under-served populations. In addition, there is the need to study inequalities in health over time to monitor progress of health delivery systems towards equitable and universal coverage and understand the evolution of the determinants.

The purpose of this paper is to investigate the effect of public and private health expenditures on selected maternal-child health outcomes in Sub-Saharan Africa (SSA).

The study utilizes panel data on 40 SSA countries spanning the period 2000-2010. The data are analyzed using the fixed effects estimation technique.

The results indicate that public health expenditure is inversely and significantly related to infant (IMRR) and under-five (U5MR) mortalities in SSA. Though public health expenditure has the a priori negative sign, it has no significant effect on maternal mortality (MMR) in SSA. Further, private health expenditure did not prove to be significant in improving maternal-child health outcomes (IMRR, U5MR and MMR) in SSA.

The implication of the findings is that a percentage point increase in public health expenditure (as a share of GDP) across the region will result in saving the lives of about 7,040 children every year. Hence, it is important for governments in SSA to increase their shares of health expenditure (public health expenditure) in order to achieve improved health outcomes.

Previous studies have not adequately explored the effect of various components of health expenditures – public and private – on health outcomes in the context of SSA. In addition to the focus on maternal-child health variables such as infant, under-five and maternal mortalities, the study accounts for the possibility of a non-linear and non-monotonic relationship between healthcare expenditures and health outcomes.

The purpose of the paper is to examine the nature and extent of gender and spatial inequalities in educational attainment in Ghana.

The paper uses the education Gini coefficient, computed on the basis of years of schooling of individuals, to assess education inequality in Ghana.

The paper finds evidence of gender and spatial inequality in education in Ghana. In particular, the three northern regions have lower education attainment as well as higher education Gini coefficients compared to the rest of the country. The paper finds evidence of intra‐gender and intra‐spatial inequalities in education attainment in Ghana, with females contributing proportionately more to the within‐inequality component of the education Gini. The paper also finds a positive correlation between poverty incidence and education inequality.

The research finds a positive correlation between poverty incidence and education inequality but requires an econometric analysis to make inferences regarding causality.

The findings call for the design and implementation of policies not only to address between‐gender and spatial inequities in education in Ghana, but also to tackle within‐gender and within‐spatial inequalities. The positive correlation between poverty incidence and education inequality implies the need to create greater equity in educational opportunities across the country.

The need for changes in attitudes, values and cultural practices that put girls at a disadvantage when it comes to education.

One important and new finding of the paper is the existence of intra‐gender and intra‐spatial inequalities in education attainment in Ghana, with females contributing proportionately more to the within‐inequality component of the education Gini.

The purpose of this paper is to examine the income strategies adopted by rural households in Ghana and analyzes the determinants of households’ choice of income portfolio.

A multinomial logit approach is employed by the paper to investigate the determinants of various income strategies adopted by households in rural Ghana.

Results indicate that household characteristics, location and infrastructure all play a role in explaining the adoption of income strategies other than a purely on-farm strategy by households. Education is a key determinant of income strategies involving non-farm wage employment, while access to credit and electricity play important roles in non-farm self-employment income strategies.

The findings of the paper call for a promotion of off-farm income opportunities to complement farm incomes and to enhance access of rural households to these sources of income.

The paper models rural household income portfolios into mutually exclusive categories which enables the application of the multinomial logit approach. The paper deviates from mainstream rural income diversification literature that has focussed on assessing the determinants of income shares.

The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.

The paper utilizes the most recent Ghana Demographic and Health Survey (GDHS V) data. The dependent variable is the intensity of utilization (number) of antenatal care visits. Hence, the negative binomial regression is employed to investigate the socio‐economic and demographic correlates of the intensity of antenatal care utilization in Ghana.

The study finds that wealth status, age, ownership of health insurance (especially for rural women), educational attainment, birth order, religion and administrative region of residence are significant predictors of the intensity of antenatal care services utilization. In particular, the utilization rate increases in wealth status. The authors also found significant statistical relationship between residence and antenatal care utilization. This finding reinforces the differences in health facilities between the rural and urban areas of Ghana. The authors did not, however, find evidence for proxies for financial and physical access.

The GDHS survey lacks data on the distance to the nearest health facility where ANC is sought and a variable for the price of ANC visit. Proxies had to be used to capture these variables.

The fact that ownership of health insurance in rural areas increases the number of ANC visits makes it imperative to intensify health insurance awareness and enrollment campaigns in the rural areas so as to bridge the rural‐urban gap in ANC utilization. Also, while the free maternal health care policy for expecting mothers is laudable, a minimum level of wealth is required to induce antenatal care visitations. This is because household wealth status still plays a major role even in a free maternal health regime.

A new finding of the paper is the significant effect that ownership of health insurance has on the utilization of ANC services among rural women. While generally rural women have a lower propensity to use ANC services compared to urban women, the intensity of usage of ANC services tends to increase for rural women who own health insurance.

The purpose of this editorial is to provide a quick glance at the dominant issues that have characterized the developing economics debate during the past five decades. It seeks to offer a backdrop for the papers in the present volume of AJEMS.

It is based on a review of a selection of literature that highlights the dominant perspectives in development economics.

It draws a distinction between soft and hard economics, arguing that economic growth must be converted into social change that benefits poor for it to be described as development-oriented.

It provides a direction for future research into issues of economic growth and poverty alleviation in Sub-Sahara Africa.

This study examines the effect of external debt and domestic capital formation on economic development in Sub-Saharan African (SSA) economies.

Using the Dynamic Common Correlation Effects (DCCE) technique and the Driscoll and Kraay fixed-effect technique, this paper conducts a multidimensional assessment of external debt and domestic investment on economic development across a panel of 35 SSA countries from 1995 to 2018. The data utilized are sourced from the World Development Indicators (2021) and the United Nations Development Program (UNDP) database (2021).

The results reveal that domestic investment has a positive impact on economic development in SSA countries, consistent across all three dimensions of the human development index (income, education and life expectancy). However, external debt exhibits an adverse effect on economic development, consistently yielding negative outcomes for life expectancy, education and income.

Based on these findings, the authors recommend that SSA economies implement appropriate policies, such as reducing bureaucratic requirements and addressing corruption, to enhance domestic capital investment. Additionally, efforts should be directed toward channeling contracted debt into productive sectors like road construction and electricity provision.

This study is among the first to assess the impact of domestic investment and external debt on the three dimensions of human development outlined by the UNDP. Furthermore, it employs a robust econometric method that considers cross-sectional dependence (CD).