Influence of public external debt on government health expenditure

A mixed-methods case study of Senegal

Bibliographic Data

ID22437485
AuthorsFrederik Federspiel (0000-0002-4295-0827, London School of Hygiene & Tropical Medicine, corresponding author), Josephine Borghi (0000-0002-0482-5451, International Institute for Applied Systems Analysis), Henning Tarp Jensen (0000-0003-4526-458X, University of Copenhagen), Elhadji Mamadou Mbaye (Université Gaston Berger), Melisa Martínez Álvarez (London School of Hygiene & Tropical Medicine)
EditorsDamen Haile Mariam (0000-0002-3229-5259)
Year2026
Volume6
Issue7
Pagese0006698
Publication date2026-07-10
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0006698
PMID42430376
OpenAlexW7167943774
LanguageEN
References cited33

Public external debt burdens of low- and middle-income countries have grown substantially over the past decade linked to increased borrowing. Our empirical understanding of how external official loans and their ensuing debt burden may impact government health spending at the individual country level is limited. We aimed to better understand these relationships through a case study of Senegal. We conducted a mixed-methods case study using descriptive quantitative analyses of loan, debt and health financing statistics in Senegal from 1970-2023. We also used the Framework method to thematically analyse semi-structured interview data collected between October 2019 and January 2020 from 25 key informants from government ministries, development partners, academia, civil society and hospital management in Senegal. We triangulated these data with findings from a purposive document review of reports from government websites and academic literature discussing loan and debt effects on government health expenditure in Senegal. Debt obligations resulting from external loans appear to have had a constraining effect on the government budget including for health. Development loans have however also supported the health sector directly. We found less support for an indirect benefit to the health budget through loans to other sectors, due to substantial decreases in government health expenditure out of general government expenditure from 2000-2022. Overall, our findings indicate that Senegal’s debt burden has constrained government health expenditure, serving as a possible co-determinant of the regression seen on the Abuja pledge since 2000. To mitigate the negative effect of debt repayment, official external creditors should consider more flexible debt repayment timelines and exploring options for debt relief including debt-to-health swaps. Supported by debt relief, increased government priority of the health sector working toward the Abuja pledge will be necessary to make progress on universal health coverage. We encourage further country level research documenting debt impacts on health financing.

Debt · Debt-to-GDP ratio · Descriptive statistics · External debt · Government (linguistics) · Government Debt · Internal debt · Pledge · Public finance · Public health · Global Health Care Issues · Global Maternal and Child Health · Healthcare Systems and Reforms

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