Institutions Matter for Sustainable Development: Economic Growth, Structural Transformation, Efficiency, and Health Outcomes in Sub‐Saharan Africa

ABSTRACT This study examines whether economic growth alone can improve population health in Sub‐Saharan Africa (SSA), where health outcomes remain weak and uneven despite sustained growth. Using unbalanced panel data from 48 SSA countries (1990–2024), it analyzes the joint effects of economic growth, institutional quality, structural transformation, and health system efficiency. Health outcomes are measured by life expectancy, infant and under‐five mortality, and non‐communicable diseases mortality, while institutional quality is captured through a composite governance index. The study applies System GMM, panel quantile regression, dynamic mediation analysis, and stochastic frontier analysis, with robustness checks using CCEMG, AMG, and Driscoll–Kraay estimators. Findings show strong persistence in health outcomes and identify institutional quality as the most consistent determinant of health outcomes. Although economic growth has a positive effect, it is modest and largely mediated through institutional quality. Structural transformation produces uneven benefits, favoring countries with stronger institutions. Efficiency analysis reveals significant performance gaps in health systems, suggesting that improved governance and service delivery—rather than increased spending alone—can substantially enhance health outcomes across SSA.

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