Health System Performance in CEMAC: A Bayesian Analysis of Key Determinants

This study examines the determinants of health system performance in the countries of the Economic and Monetary Community of Central Africa (CEMAC) over the period 2007–2021. The analysis focuses on Cameroon, Chad, Gabon, Equatorial Guinea, the Central African Republic, and the Republic of Congo. Health systems in the region continue to face major structural constraints characterized by insufficient financing, weak governance, shortages of qualified health personnel, unequal access to healthcare services, and limited technological integration. In this context, identifying the main determinants of health system performance remains essential for improving healthcare delivery and achieving sustainable development objectives. The study adopts a multidimensional framework integrating economic, social, institutional, and technological determinants. Methodologically, the research relies on an unbalanced panel dataset and employs three complementary econometric approaches: Bayesian Model Averaging (BMA), Weighted Average Least Squares (WALS), and General-to-Specific Modelling (GenSpec). The Bayesian Model Averaging approach is particularly relevant because it explicitly addresses model uncertainty and simultaneously evaluates multiple competing explanatory variables, thereby reducing omitted variable bias and strengthening the robustness of the empirical analysis. The findings reveal that GDP per capita, financial development, life expectancy, government health expenditure, and final government consumption expenditure positively influence health system performance in the CEMAC region. These variables contribute to improving healthcare financing, infrastructure development, access to medical technologies, and the efficiency of healthcare delivery. In contrast, corruption negatively affects health system performance by weakening governance quality and generating inefficient allocation of public resources. The robustness analysis further identifies political stability, internet access, education, and trade openness as important complementary determinants supporting healthcare modernization and resilience. This study contributes to the literature by providing one of the few empirical analyses specifically focused on health system performance in the CEMAC region while combining Bayesian and classical model selection approaches to strengthen the reliability of the findings. The results suggest that strengthening governance, increasing public investment in health, promoting anti-corruption reforms, and accelerating digital transformation are essential policy priorities for improving health system performance and healthcare resilience in Central Africa. The study also emphasizes the importance of coordinated regional cooperation for achieving sustainable and equitable healthcare development objectives.