Malaria is a significant public health concern, particularly in sub-Saharan Africa. This study examined the impact of health care expenditure and access to basic sanitation services on malaria incidence in 28 selected African countries from 2000 to 2019.

The study was anchored on Health Production Function [HPF] model while General Panel Linear Model was adopted to examine the relationships between the variables. The retrospective research design was utilised. The statistical diagnostics tests were performed to check for multicollinearity, hereroskedasticity, normality and model specification using correlation matrix, Breusch Pagan/Cook Weisberg, Shapiro–Wilk and the Hausman specification. The hypotheses were tested at the 5% significance level and the analysis of the data was aided by the use of the STATA 13.0.

Domestic Government General Health Expenditure [DGGHE] had a positive relationship with Malaria Incidence [MI], although it was not statistically significant [coefficient = 0.0454708, p-value = 0.604]. Out-Of-Pocket Health Expenditure [OOPHE] demonstrated a statistically significant positive association with MI [coefficient = 0.2839394, p-value = 0.009]. External Health Expenditure [EHE] showed a statistically significant negative relationship with MI [coefficient = − 0.1452344, p-value = 0.012]. Moreover, People using at least Basic Sanitation Services [PBSS] exhibited a statistically significant negative relationship with MI [coefficient = − 0.3854207, p-value = 0.000].

The results suggested that while government health expenditure alone may not significantly impact malaria incidence, increased out-of-pocket expenditure and external health expenditure, as well as improved access to basic sanitation services, are associated with a higher likelihood of reducing malaria incidence in the selected African countries. Addressing malaria incidence in Africa requires a comprehensive approach that includes adequate government health care expenditure, reduction of out-of-pocket costs, increased external funding, and improved access to basic sanitation services. By implementing these recommendations, policymakers can make significant progress in reducing the burden of malaria and improving public health outcomes in affected African countries.