Table 1.
Structural equation modeling results—pathways to health outcomes.
| Pathway | Direct Effect | Indirect Effect | Total Effect | Standard Error | P-value |
|---|---|---|---|---|---|
| Pathways to UHC SCI | |||||
| Governance → Health Financing → UHC SCI | 0.32*** | 0.18*** | 0.50*** | 0.07 | <0.001 |
| Governance → Health Workforce → UHC SCI | 0.28*** | 0.15*** | 0.43*** | 0.06 | <0.001 |
| Health Financing → Service Delivery → UHC SCI | 0.41*** | 0.12*** | 0.53*** | 0.08 | <0.001 |
| Digital Health → Service Delivery → UHC SCI | 0.19*** | 0.09*** | 0.28*** | 0.05 | <0.001 |
| Governance → Digital Health → UHC SCI | 0.24*** | 0.11*** | 0.35*** | 0.06 | <0.001 |
| Pathways to Under−5 Mortality | |||||
| UHC SCI → Health Service Access → U5MR | −0.38*** | −0.22*** | −0.60*** | 0.09 | <0.001 |
| Health Financing → Health Workforce → U5MR | −0.25*** | −0.14*** | −0.39*** | 0.07 | <0.001 |
| Governance → Health System Efficiency → U5MR | −0.31*** | −0.17*** | −0.48*** | 0.08 | <0.001 |
| Pathways to Catastrophic Expenditure | |||||
| Health Financing (OOP) → Financial Protection → CHE | 0.46*** | 0.21*** | 0.67*** | 0.10 | <0.001 |
| Governance → Health Financing Mix → CHE | −0.29*** | −0.16*** | −0.45*** | 0.08 | <0.001 |
| Social Health Insurance → CHE | −0.34*** | −0.18*** | −0.52*** | 0.09 | <0.001 |
| Model Fit Statistics | |||||
| Comparative Fit Index (CFI) | 0.93 | ||||
| Tucker–Lewis Index (TLI) | 0.91 | ||||
| Root Mean Square Error of Approximation (RMSEA) | 0.04 | ||||
| Standardized Root Mean Square Residual (SRMR) | 0.03 | ||||
Source: Author’s calculations using Mplus 8.8. All coefficients are standardized. UHC SCI, UHC service coverage index; U5MR, under-5 mortality rate; CHE, catastrophic health expenditure; OOP, out-of-pocket. Model estimated with maximum likelihood with robust standard errors. All pathways shown are statistically significant at p < 0.01.
***
p < 0.01.