The study investigates the role of governance quality on the effect of health expenditure on health outcomes captured by life expectancy at birth, infant mortality, under-five mortality, crude mortality and maternal mortality rates in West African Countries. Although these countries have made significant efforts to increase health expenditure over the years, health outcomes have only responded marginally in West African Countries, raising concerns about the importance of health expenditure in improving health outcomes. This study analyses the relationship between the role of governance and health expenditure and health outcomes using the feasible generalised least squares estimation techniques. The data for the study were sourced from the World Development Indicators and World Governance Indicators for the 15 West African countries from 1996 to 2022. The findings indicate that improving the governance composite index improves selected health outcomes in West African Countries. Furthermore, improving the interaction term between the composite index of governance and health expenditure improves health outcomes in West Africa. Therefore, the study recommends that governments make conscious efforts to allocate more resources to the health sector to improve health outcomes
and fully implement universal healthcare coverage (UHC) as the Côte d'Ivoire government in 2012 to alleviate high poverty levels and health expenses for people. Also, to improve public funds' efficiency and effectiveness and achieve better health outcomes, it is imperative to implement national policies on the institutional environment, and consistently improve governance issues plaguing the health sector. Increasing the salaries of public health workers could help to curb corruption and income inequality and improve their living and working conditions. Doing so will enable the West African countries to achieve health goals and agenda, as outlined in the SDGs.