Nine years after Abuja targets were set, African countries fail to allocate sufficient resources to health

Yesterday, on the eve of the World Health Assembly and Pre-African Union (AU) Summit of African Health Ministers, a statement was issued by Archbishop Desmond Tutu and the Africa 15% Plus Campaign expressing concern about the lack of progress being made by African countries to allocate sufficient resources to health.

In April 2001, African Health Ministers met at a special summit in Abuja, Nigeria. The summit concluded with the adoption of the Abuja Declaration, which outlined the continent’s response to HIV and AIDS, tuberculosis (TB) and other related infectious diseases. In that declaration, among other commitments the leaders of Africa promised to spend 15% of their national budgets on health. Nine years on, it is clear that most countries are not on track to meet this promise.

A scorecard has been produced by the 15% Plus Campaign to highlight countries’ progress towards the 15% target. The scorecard shows that only 6 out of 53 AU Member States (Rwanda, Botswana, Niger, Malawi, Zambia and Burkina Faso) have so far met the Abuja Commitment to spend 15% of their budgets on health – so in most countries, governments are not living up to their commitments on health spending.

The scorecard also shows how much African countries are spending on the health of each person. This presents a very different picture and is arguably a more important indicator of whether sufficient investment is being made in the health of a country’s population. Rwanda, for example, is top of the chart on the proportion of its budget spent on health (18.8%) however this only amounts to $14 of health expenditure per person. By contrast, Equatorial Guinea is low on the table as it spends only 6.9% of its budget on health but this equals $353 per person, the second highest figure after the Seychelles and a clear exception in a table showing most countries investing $14 or less.

The massive contrast here is due to the different sizes of the two governments’ overall budgets – Rwanda is one of the poorest countries in Africa, whereas Equatorial Guinea is an oil-rich nation. While the Rwandan government is clearly meeting its obligations under the Abuja declaration, the fact that its spending per person remains so low demonstrates the crucial role of external resources, for example from donors, in ensuring Rwandans can access quality healthcare.

The World Health Organization recommends a minimum government spend of $40 per person on health. The scorecard shows that 32 African countries are investing less than $20 per capita in health with 11 countries investing as little as $1 to $5 per person.  To put this into perspective, average per capita expenditure on health in Europe and North America is estimated to be around $1,300.

Rotimi Sankore, Coordinator of the Africa Public Health Alliance & 15% Plus Campaign, explained yesterday why investment needs to increase: “$1 can barely provide a day’s dose of aspirin or treat a case of malaria, $5 cannot treat a case of TB, and $20 cannot provide HIV treatment, tackle leading causes of child mortality, or provide a health workforce for health needs of all citizens, especially skilled birth attendance necessary to reduce maternal mortality.”

In addition to calling for African countries to accelerate efforts to meet the Abjua target, Archbishop Tutu and African civil society have called for a high-level review to take place so that “we can understand better why after 9 years, only 6 out of 53 AU members have met the 15% pledge”. RESULTS and other organisations from the developed world should continue to support our African colleagues to ensure that their governments live up to their commitments and that the UK and other donors support African countries to deliver quality healthcare to all of their citizens.


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