{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T20:30:29Z","timestamp":1786566629816,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp;amp; Management"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Sub\u2010Saharan Africa (SSA) continues to experience a high and uneven disease burden, mainly from HIV\/AIDS, tuberculosis, and malaria. As external funding declines, the strategic allocation of domestic public health spending (DPHS) becomes crucial. This study assesses whether directing DPHS towards major diseases and high\u2010burden areas improves health outcomes across 43 SSA countries between 2003 and 2022, using DALYs as the outcome measure. Results show a statistically significant positive relationship between DPHS and DALYs: HIV\u2010specific models yield coefficients of 0.105\u20130.288 (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0&lt;\u00a00.01), and all\u2010cause models yield coefficients of 0.071\u20130.085 (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0&lt;\u00a00.05), while other models are insignificant. The paradoxical positive association\u2014stronger in high\u2010burden settings\u2014suggests that DPHS is reactive, mainly used to address existing disease burdens rather than prevent them. The significant persistence of DALYs, especially in low\u2010burden and high\u2010burden contexts, further indicates that spending is directed towards treatment and case management rather than preventive measures. The DPHS effect on tuberculosis or malaria outcomes in DALYs is slightly greater in low\u2010burden areas. Beyond health spending, factors such as economic growth, inequality, population ageing, and governance substantially influence health outcomes. Overall, the findings highlight that while DPHS remains essential, its current reactive deployment limits effectiveness. A systemic shift is needed towards proactive, preventive approaches with targeted health interventions to reduce the region's disease burden.\n                  <\/jats:p>","DOI":"10.1002\/hpm.70104","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T19:57:30Z","timestamp":1786564650000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Domestic Public Health Spending on Health Outcomes in Sub\u2010Saharan Africa: Evidence From Disability\u2010Adjusted Life Years"],"prefix":"10.1002","author":[{"given":"Wa Ntita","family":"Serge Kabongo","sequence":"first","affiliation":[{"name":"School of Accounting, Economics and Finance University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6014-233X","authenticated-orcid":false,"given":"Josue","family":"Mbonigaba","sequence":"additional","affiliation":[{"name":"School of Accounting, Economics and Finance University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.19871\/j.cnki.xfcrbzz.2024.06.016"},{"key":"e_1_2_12_3_1","volume-title":"Global Health Observatory","author":"World Health Organisation","year":"2024"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oneear.2022.01.003"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12961\u2010024\u201001159\u2010x"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1467\u20108268.12287"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/0376835X.2024.2302507"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(25)01240\u20101"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0247413"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssaho.2023.100570"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2023.2229892"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/RRTM.S382288"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czad092"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591\u2010022\u201001990\u20101"},{"key":"e_1_2_12_15_1","volume-title":"Global Lists of High Burden Countries for TB, multidrug\/rifampicin\u2010resistant TB (MDR\/RR\u2010TB) and TB\/HIV, 2021\u20132025","author":"WHO","year":"2021"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304\u20104076(94)01641\u2010C"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1086\/259880"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10754\u2010012\u20109120\u20103"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1108\/IJSE\u201006\u20102020\u20100404"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpolmod.2018.09.001"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/economies12060129"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/19452829.2013.765392"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1108\/IJDI\u201010\u20102019\u20100169"},{"key":"e_1_2_12_24_1","volume-title":"UNAIDS Global AIDS Update 2023","author":"p. t. e. 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