Remittances, Health Financing Systems, and <scp>SDG</scp> Three Outcomes in Africa

ABSTRACT Africa continues to face persistent challenges in achieving Sustainable Development Goal 3 (SDG 3), despite expanded health initiatives and renewed global commitments. At the same time, remittances have become one of the continent's most stable external financial inflows, often exceeding foreign aid and foreign direct investment. Yet the extent to which these private transfers improve population health remains uncertain, especially in health‐financing systems characterized by underfunding, fragmentation, and high out‐of‐pocket burdens. This study examines how remittances interact with national health‐financing structures to influence SDG 3 outcomes across 48 African countries from 2000 to 2022. Using a multidimensional Health Financing Capacity Index and applying second‐generation estimators—Cross‐Sectional ARDL (CS–ARDL), Common Correlated Effects Mean Group (CCEMG), and Augmented Mean Group (AMG)—the analysis reveals three main findings. First, remittances have a positive but modest direct effect on SDG 3 performance. Second, structural financing indicators, particularly, government health spending and financial protection, are the strongest long‐run determinants of health outcomes. Third, interaction models show that remittances yield greater health benefits in weak or high–out‐of‐pocket systems, while their marginal impact declines in stronger financing environments. Overall, the results indicate that remittances cannot substitute for robust and sustainable health‐financing frameworks. Their developmental value depends on the institutional capacity of national systems to convert household transfers into effective health gains. The study offers new evidence to guide integrated SDG financing strategies that align private remittances with structural reforms in Africa's health sector.