Sub-Saharan Africa’s public health expenditure as a percentage of gross domestic product (GDP) has fallen by more than 15% in just five years, the latest data on the subject has revealed.
According to the ‘Ibrahim Forum Report’, a 2018 analysis, Sub-Saharan Africa has the second smallest public health expenditure of all regions, far below the world average.
The statistics, which were compiled by the Mo Ibrahim Foundation between 2009 and 2014, found that five out of the ten African countries with the largest public health expenditures as a percentage of total government expenditure are also among the ten countries with the highest share of external financing of their total health expenditure
“Citizens’ dissatisfaction with how their government is addressing educational and health needs has grown over the last decade,” said the researchers.
The analysis was compiled by the Mo Ibrahim Foundation’s Nathalie Delapalme – Executive Director of Research and Policy; Camilla Rocca – Senior Research Analyst; Diego Fernández Fernández – Analyst; Richard Kweitsu – Research Intern; Carolina Rocha da Silva – Researcher; Zainab Umar – Researcher and Operations Manager; and Yannick Vuylsteke – Head of the Ibrahim Index of African Governance.
They discovered that in 2014, the latest available data year, Sub-Saharan Africa spent, on average, 2.3% of its GDP on public health expenditure, a decline of -15.1% compared to its largest decennial budget in 2009 (2.7%).
“The region has the second smallest public health expenditure globally, only ahead of South Asia and is far below the world average of 6.0%,” said Delapalme and her team.
In the latest data years for which regional averages were available for the world and sub-Saharan Africa (2011 and 2010, respectively), while the global average of public health expenditure as a percentage of government expenditure was 15.7%, sub-Saharan Africa’s average was 11.9%.
In 2014, the latest data year for which there is country-level data, the ten African countries with the highest public expenditure on health were Burundi, the Central African Republic (CAR), Djibouti, Ethiopia, Gambia, Malawi, Namibia, South Africa, Swaziland and Tunisia, all of them spending 13.2% of their total government expenditure at least.
Five out of the ten African countries with the largest public health expenditure – Burundi, CAR, Ethiopia, Gambia and Malawi – are also among the ten countries with the highest share of external financing of their total health expenditure.
Four countries – Cameroon, Eritrea, Libya and South Sudan – spent less than 4.0% of their public budget on health in 2014.
With only $98.2 per capita, the 2014 sub-Saharan African average per capita health expenditure in current US Dollars is more than ten times lower than the global average of $1,058.5.
The ten African countries that spend the most are Algeria, Botswana, Equatorial Guinea, Gabon, Libya, Mauritius, Namibia, Seychelles, South Africa and Tunisia, all of them spending more than $300.0 per capita on health.
The three countries that spent less than $20.0 per capita in 2014 are CAR, Democratic Republic of Congo (DRC) and Madagascar.
This state of affairs brings to light an initiative known as the 2001 Abuja target. In 2001 in Abuja, African Union (AU) member states pledged to increase government funding for health to at least 15.0% of their annual budget.
However, more than ten years later, in 2014, only four countries – Malawi, Swaziland, Ethiopia and Gambia – have met the Abuja target, spending more than 15.0% of their annual budget on health, which is 16.8%, 16.6%, 15.7% and 15.3%, respectively.
To address these issues, the Foundation cites recommendations from the United Nations (UN), the African Union and the Organisation for Economic Co-operation and Development (OECD), which call for the aligning national visions to the 21st century tasks.
The organisations have urged Sub-Saharan Africa’s governments to take a leading role in the mobilisation process and allocation efforts in terms on national resources.
The Foundation believes that if these targets are met, the region will achieve the same level of health sector development as other frontier economies.